WRIST-JOINT (ABNORMAL ANATOMY). 



1513 



luxation of the wrist, has been at least half 

 an inch lower down than the level of the 

 carpal extremity of the radius. The reverse, 

 however, of this I have lately seen, in a case 

 of congenital luxation of the wrist, under 

 Dr. M'bowel's care, in the Whitworth Hos- 

 pital. In this case, of which Dr. Gordon has 

 been kind enough to present me with a cast, 

 the radius has, at its lower extremity, passed 

 half an inch lower down on the back of the 

 carpus than the ulna ; varieties have been also 

 noticed as to the carpus ; in some cases the 

 bones of the carpus were not only malformed, 

 but deficient in number ; in one case nine 

 bones were found. 



There are other congenital malformations of 

 the wrist-joint which demand some attention 

 from the physician and surgeon, such as 

 affections of the wrist analogous to valgus, 

 and cases of the foot and ankle, but we do 

 not consider this the place to discuss these 

 cases. 



We may make the same remark as to those 

 congenital defects of the hand with deformity 

 of the wrist, which have been noticed to co- 

 incide with a deficiency in the brain on the 

 side opposite to the deformity. 



ACCIDENT. The principal lesions which 

 the structure that compose the region of the 

 wrist are liable to, are : 



1st. Dislocations of the wrist and neigh- 

 bouring radio-ulnar articulations. 



2nd. Dislocations of the bonesof the carpus. 

 3rd. Fractures of the lower extremities of 

 the bones of the forearm, in the immediate 

 vicinity of the wrist-joint. 



1st. Dislocations. Dislocations and frac- 

 tures of the bones entering into the com- 

 position of the wrist-joint are two kinds 

 of lesions, which for a long time have 

 been confounded together, or mistaken for 

 each other. Even in modern times authors 

 have stated the wrist-joint to be liable to 

 numerous luxations. Thus, Boyer, Petit, Mr. 

 Samuel Cooper, &c. &c., entered into a de- 

 scription of the different dislocations of the 

 wrist, as forwards, backwards, inwards, and 

 oulwirds, complete and incomplete, just as 

 Hippocrates and others, down to Celsus, had 

 done. 



Nevertheless, some moderns, at the head 

 of whom we would place Dr. Colics of Dublin, 

 Dupuytren, and Sir Benjamin Brodie, main- 

 tained that luxations of the wrist-joint from 

 accident were either impossible, or, at all events, 

 exceedingly rare, and expressed their opinion 

 that authors had, under the erroneous name 

 of dislocation, really described an accident 

 now pretty generally believed to be a frac- 

 ture of the radius in the immediate vicinity 

 of the wrist-joint, with displacement back- 

 wards of the carpus and hand. 



Velpeau followed these, and not only de- 

 nied the reality of such an accident as simple 

 dislocation of the wrist, but gave his reasons 

 why he believed that no such accident could 

 occur, observing, that the strong tendons of 

 the flexor muscles of the forearm, bound 

 down by the anterior annular ligament of the 



carpus, must render impossible any luxation 

 of the bones of the forearm forwards at the 

 wrist-joint, during any forcible bending back- 

 wards of the hand, such as might, for example, 

 be produced by a fall on the palm ; and, 2nd!y, 

 that the common and radial extensor (re- 

 strained as they are by the posterior annular 

 ligament), oppose any luxation of the bones 

 of the forearm backwards at the wrist during 

 a movement which should produce an extreme 

 flexion of the hand forwards. 



Velpean, however, admitted, that from ex- 

 periments he had made on the dead subject, 

 he had learned that efforts of a different order, 

 such as a forcible pulling, accompanied witli 

 a simultaneous bending of the hand, whether 

 backwards or forwards, inwards or outwards, 

 might break every tissue, and produce a lux- 

 ation without any fracture of the radius. Such 

 cases, he says, he believes will always be ac- 

 companied with a wound of the integuments, 

 and are not to be looked upon as the simple 

 dislocations we are now considering, nor 

 should they, in his opinion, enter into the 

 same category with them. 



In support of the doctrine, that most, if 

 not all, of the simple dislocations of the 

 wrist, of the authors already alluded to, were 

 really fractures of the lower extremity of the 

 radius, we confess that one observation of 

 Velpeau appears particularly strong, viz., that 

 for the last thirty or forty years in which the 

 question has been discussed, and the reality 

 of the luxation disputed, no one has brought 

 forward one instance which, rigidly examined, 

 he would look upon as an incontestable exam- 

 ple of a simple luxation of the wrist-joint. 

 He admits that the solitary case adduced by 

 Voillemier is a very notable one, and de- 

 serving of attention, but that in his opinion, 

 the question is still open as to whether a sim- 

 ple luxation of the wrist-joint can occur, 

 without there being at the same time any 

 lesion of the edges of the articular surfaces, 

 or of the integuments. 



We think we cannot do better than here 

 give an abstract of this remarkable case, given 

 by Voillemier.* 



" Levillain Louis, set. 27, of a vigorous con- 

 stitution, on the 28th Sept. 1839, was ad- 

 mitted under the care of M. le Noris, into 

 the Hopital des Cliniques (Paris) ; at the 

 moment of admission he was in a hopeless 

 state, completely insensible ; the pupils largely 

 dilated, the respiration stertorous. Amongst 

 other lesions from which the patient had suf- 

 fered, in consequence of his having fallen into 

 a court-yard from a window three stories high, 

 to the ground, it was noticed specially that 

 the left wrist-joint presented a very remarkable 

 deformity, and of such a nature that Voille- 

 mier, prejudiced as he said he felt he was, 

 that a luxation of the wrist was a great rarity, 

 if not an impossibility, could not help saying 

 to his colleague, M. Dumeril, present at the 

 examination of the patient, that the case be- 



* See Archives Gunuralcs clc Mcik'cinc, Deccnib. 

 IftJ'J, p. 4UO. 



