The Dublin Journal of Medical Science, Vol. 143

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Excerpt from The Dublin Journal of Medical Science, Vol. 143: January to June, 1917 Pronation and supination are lost, and there is fixation of the wrist tendons, and to all intents and purposes the hand, as you now see it, is useless. I have warned you many times that no fracture should be left without frequent examination to see that the bone line is good and the circulation below the line of fracture perfect. "Meddlesome surgery is bad surgery" is a sound axiom, but proper supervision is sound in practice. Had this arm been taken out of splints, massaged, and then properly replaced, five weeks would have seen this poor fellow at work fit and well, now, as the photographs show, deformity still exists, and worse, the radius has become fixed to the ulna, this prevents lateral movements of the forearm. The second x-ray of this case shows the position of the radial fragments when fracture occurs about the middle of the forearm. The upper one is flexed by the biceps (Plate II., Fig. 4), while the lower is drawn towards the ulna by the pronator quadratus. Plate II., Fig. 3, shows this perfectly, and also shows that the bones have united in this faulty position. These two plates indicate the proper method of setting such fractures. By grasping the hand firmly and forcing it ulnarwards, the lower fragment is brought into line, then flex to a right angle at the elbow, and place the limb in a position of semipronation. This procedure brings the lower into line with the upper fragment. The proper treatment, apart from open operation, of which I shall speak to you later, is to apply a broad posterior splint wide enough to prevent the bandage pressing on the radial fragments, and extending from the elbow to the dorsum of the hand, a short and narrow interosseous splint with scant padding presses the flexor muscles between the radius and ulna, and thus prevents the serious trouble which has occurred in this case. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully, any imperfections that remain are intentionally left to preserve the state of such historical works.