A clinical, pathological, and experimental study of fracture of the lower end of the radius : with displacement of the carpal fragment toward the flexor or anterior surface of the wrist / by John B. Roberts.

John Bingham Roberts

Date:: 1897

Credit: A clinical, pathological, and experimental study of fracture of the lower end of the radius : with displacement of the carpal fragment toward the flexor or anterior surface of the wrist / by John B. Roberts. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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$will be exceedingly painful, but is so quickly done that, as a rule, etherization is unnecessary. If sufficient force is applied the fragments will be driven into place at once with a coarse grat- ing sensation. Occasionally a repetition of the manipulation may be needed to obtain perfect restoration of the bony contour. This manipulation is the same that I use in reducing the fracture with dorsal displacement, but is applied to the palmar surface instead of to the dorsal. In fractures which have been left unreduced for several weeks more power will be required because the reduction then becomes a refracture. Here it maybe necessary to bend the united bone across the surgeon's knee, which is applied to the front of the forearm at the level of the fracture. After the fragments have been broken apart by extension and counter-extension, and a cross-breaking strain over the knee, applied to the palmar S'lr- face so as to tend to increase the displacement, coaptation is to be accomplished by the manipulation just given for the reduction of recent fractures. As in the ordinary fracture of the base of the radius, immedi- ate and complete reduction is the essential of treatment. If reduction is perfect there will be little trouble in most cases, and restoration of function will be prompt and perfect. Stiff- ness, pain, and other discomforts are due to imperfect reduc- tion, which interferes with the movement of the tendons and probably causes injurious nerve pressure. Most cases will probably show little tendency to reproduc- tion of deformity, for the broad serrated surfaces of the frag- ments will hold them in apposition, and there is little tendency to displacement from muscular action. In cases with little or no comminution and with a transverse line of fracture, a cuff or wristlet of superimposed layers of adhesive plaster three inches wide, extending an inch and a half below and an inch and a half above the wrist-joint, and made sufficiently thick to prevent motion of the wrist, will be all that is necessary in the way of splint. If-the lower fragment is comminuted or easily displaced be-$