WRIST-JOINT (ABNORMAL ANATOMY). 



example of it; and Dupuytren mentions that 

 he has met with but two. Sir A. Cooper 

 refers to only one case of dislocation of the 

 lower extremity of the ulna. In this case the 

 bone was thrown backwards. 



Luxation of the lower extremity of the ulna 

 at the wrist-joint, backwards. Desault has 

 published the history of a washerwoman who 

 had a luxation of the inferior extremity of the 

 u'.na backwards^ in consequence of the violent 

 and sudden pronation in which the wrist had 

 been forced into while she was in the act of 

 wringing clothes. 



In this luxation, backwards, the forearm and 

 hand are in a state of forced pronation, and 

 the two bones are strongly crossed, forming 

 witli each other a very acute angle of decus- 

 sation ; the inferior part of the forearm is 

 much narrower than in the normal state ; the 

 forearm, the hand, and the fingers, are main- 

 tained in a state of moderate flexion, but 

 fixed ; the tendons of the flexor muscles of 

 the finger are, as it were, matted together into 

 a single fasciculus, displaced inwards, and 

 form a sensible saliency upon the ulnar border 

 of the radius. 



What strikes one most, in looking at the 

 back part of the wrist, is the very manifest 

 projection on the dorsum of the region, formed 

 by the lower extremity of the ulna, which 

 rises so much above the level of the back of 

 the hand. 



Luxation forwards. Desault, Boyer, and 

 Dupuytren have each adverted to this dislo- 

 cation, in which we observe an oblique cross- 

 ing of the bones of the forearm ; the fingers 

 are semittexed, and there is a remarkable 

 narrowness of the inferior part of the limb. 

 The forearm and hand are fixed into a state 

 of supination, the saliency of the ulna is per- 

 ceived in front, the tendons of the flexor 

 muscles are pushed outwards towards the 

 radius, and the inferior part of the ulna, 

 instead of being parallel to that of the radius, 

 as in the normal state, is oblique from above 

 downwards, from within outwards, and from 

 behind forwards. 



Boyer gives the following remarkable ex- 

 ample of this accident. In 1791, a woman 

 of a strong constitution, and of a spare, though 

 muscular frame, while in a state of intoxica- 

 tion, looking at two persons playing "domino" 

 in a cafe, in Paris, foolishly ventured some 

 advice to the players, who besought her not 

 to interrupt them. She, however, thought 

 proper to persist in giving her gratuitous 

 advice, until at last one of the players, a 

 strong and vigorous man, got up in a very 

 angry mood, seized her violently by the right 

 hand and endeavoured to push her out of the 

 room. In this movement her hand and fore- 

 arm were carried suddenly into a state of 

 preternatural supination. Immediately the 

 woman experienced the most acute pain, 

 and cried out that her wrist was broken. 

 The pain, the deformity, and the impossi- 

 bility she experienced of executing the or- 

 dinary movements of the forearm, made 



1515 



her fear that she was most seriously injured' 

 "I was called in," says Boyer, "instantly, 

 and I found the patient complaining of most 

 acute suffering, having the forearm flexed, the 

 hand fixed in a forced state of supination. 

 The least effort to communicate a movement 

 of pronation caused the patient the most acute 

 aggravation of her sufferings. The ulna 

 formed a very sensible prominence anteriorly, 

 and this bone, instead of being parallel to the 

 radius, formed with it an acute angle, crossing 

 its direction somewhat, and passing down- 

 wards, forwards, and outwards." All these 

 symptoms taken together left no doubt on 

 the mind of Boyer, but that the case he had 

 to deal with was one of luxation forwards of 

 the lower extremity of the ulna. It was not 

 until after having tried thrice unsuccessfully 

 that at length he succeeded in reducing the 

 dislocation. 



Luxations of the inferior extremity of the 

 ulna forwards from the scaphoid cavity of the 

 radius are, according to the opinion also of 

 Dupuytren, excessively rare, at least, " in 

 the course of my long practice," he says, " I 

 have met with but two casts of this accident." 

 One of these cases he gives us a detail of, as 

 follows : Case. M. Blot, an officer of the 

 gendarmerie, get. 32, of a sanguine tempera- 

 ment and athletic constitution; while on duty 

 daring the night, the horse upon which he was 

 mounted took fright, reared up, and fell back 

 with his rider. The latter was happy enough 

 during the fall to disengage himself nearly 

 from the animal, with the exception that his 

 right arm was placed between the head of the 

 horse and the ground, and thus received a 

 violent shock. M. Blot, considering his fore- 

 arm broken, applied to two surgeons, who, 

 each in succession, recognised a dislocation 

 of the ulna at the wrist, and each, also, failed 

 in reducing the dislocation. M. Blot came to 

 Paris, suffering much, and applied at the 

 Hotel Dieu to Dupuytren, on 25th November. 

 He then laboured under the following symp- 

 toms : The forearm was much swollen ; the 

 hand was in a median position between pro- 

 nation and supination ; the inferior part of the 

 forearm was deformed, rounded or rendered 

 cylindrical near the wrist-joint by the diminu- 

 tion of its bilateral diameter a remarkable 

 saliency existed within and in front, formed 

 by the lower extremity of the ulna thrown 

 forwards towards the palmar aspect behind, 

 a remarkable depression replaced the ac- 

 customed prominency formed by the lower 

 extremity of the ulna (la malleole interne) ; 

 indeed, behind, a depression existed ir.sie<Ml 

 of the saliency ordinarily formed by the head 

 of the ulna. If we followed with the fin- 

 gers the ulna, from the elbow even to the 

 hand, we perceived that this bone directed 

 itself obliquely forwards and outwards in 

 crossing and pacing over the inferior part 

 of the radius. The luxation of the radius 

 forwards became then evident. There was 

 no crepitation. The movements of pronation 

 and supination were completely lost. Du- 



