WRIST-JOINT (ABNORMAL ANATOMY), 



1517 



the forearm. The wrist broke and became 

 immediately deformed. The dissection re- 

 vealed a simple and transverse fracture of the 

 carpal extremity of the radius, with a dis- 

 placement backwards of the lower fragment, 

 as with ordinary cases of fracture of the 

 radius in the immediate vicinity of the wrist- 

 joint, a species of injury, which in this city is 

 known by the name of" Colics' fracture." 



It would also appear to Malgaigne, Bouchet, 

 and Voillemier, that this fracture may be the 

 result of a sudden and violent flexion of the 

 hand without the patient having had any fall. 

 This fact was first established by Bouchet, 

 who, in endeavouring to produce dislocation 

 of the wrist on the dead body, only caused in 

 his experiments fractures of the inferior ex- 

 tremity of the radius ; sometimes with other 

 disorders, and more particularly with a simul- 

 taneous fracture of the styloid process of the 

 ulna. 



Symptoms. If Colles' fracture of the 

 radius be produced by a fall, the patient will, 



sometimes, be able to say that at the moment 

 of the accident he felt a sensation of some- 

 thing having given way near to the wrist-joint. 

 The inferior extremity of the forearm ami 

 the hand swell ; the finger^ are semi-Hexed, 

 and the patient experiences the greatest diffi- 

 culty in performing the ordinary movements 

 of the hand, or forearm. He usually pre- 

 sents himself to us with the hand of the 

 injured forearm resting on its ulnar margin, 

 and supported by the other hand, and in a 

 middle state between pronation and supina- 

 tion. 



The posterior surface of the forearm usually 

 represents a considerable deformity ; for a 

 depression is seen to exist about one inch 

 above the line of the wrist-joint, whilst a con- 

 siderable swelling occupies the wrist itself and 

 metacarpus ; indeed, the carpus and base of 

 the metacarpus, appear to be thrown back- 

 wards so much, as at first view to excite a 

 suspicion that the radius had been dislocated 

 forwards, and the carpus and hand back- 



iff. 930. 



" Colics' Fracture." 



wards (Jig. 930.). On viewing the anterior sur- 

 face of the limb we observe a considerable 

 fulness, as if caused by the flexor tendons 

 being thrown forwards ; this fulness extends 

 upwards, to about one-third of the length of 

 the forearm, and terminates below at the 

 upper edge of the annular ligament of the 

 wrist. 



The inferior fragment of the radius being 

 salient posteriorly, while the superior is 

 thrown forwards, the injured forearm, viewed 

 side-ways, resembles, in the undulating direc- 

 tion of its long axis, the outline, according 

 to Velpeau's idea, of a silver dinner-fork. 

 Besides presenting this very striking de- 

 formity, in this fracture we find the hand oc- 

 casionally thrown outwards, or towards the 

 radial side, and then the carpal extremity of 

 the ulna presents a strong saliency internally. 

 The degree, however, in which this projec- 

 tion towards the inner edge of the wrist takes 

 place, will be found to vary. 



The patient is unwilling to attempt to pro- 

 nate or supinate his hand, and if we endea- 

 vour to communicate such movements, much 

 pain is produced. There is considerable pain 

 felt by the patient when we press firmly with 

 the point of the finger in the exact situation 

 of the fracture. 



The internal lateral ligament of the wrist- 



joint is generally put upon the stretch, and 

 the patient usually complains of much distress 

 here ; but this pain, which some patients feel 

 about the lower extremity of the ulna, does 

 not always arise simply from a sprain coin- 

 cident with the fracture or from a rupture of 

 the internal lateral ligament of the articula- 

 tion of the carpus with the forearm, but we 

 believe sometimes is owing to a fracture of 

 the root of the styloid process of the ulna. 



It is in this last case more particularly that 

 the hand "par un mouvement de totalite," is 

 carried outward*, and that the ulna seems vert/ 

 salient, internally (Jig. 9'il.). 



A narrowing of the region of the wrist, in 

 the transverse direction, has been much ad- 

 verted to by Dupuytren, as a s\mptom of the 

 fracture we arc now considering, but we 

 believe this narrowing is, in general, more ap- 

 parent than real. We rather concur with 

 Velpeau, who says, " Many observations have 

 induced me to believe that Dupuytren, and 

 others, have been deceived as to the supposed 

 narrowing of the wrist." He adds, an in- 

 terosseous space, in reality, does not exist 

 near to the wrist joint; indeed, there is scarcely 

 any open interval to be seen between the 

 lower extremity of the radius and ulna for the 

 space of one inch above the line of the radio- 

 carpal articulation. Now, fractures ordinarily 



