344 



APPLIED ANATOMY. 



SEPARATION OF THE LOWER EPIPHYSIS OF THE RADIUS. 



The lower radial epiphysis fuses with the shaft at about the twentieth year ; 

 therefore epiphyseal separation can occur up to that time. The epiphyseal line 

 passes across the bone from the base of the styloid process 

 to the upper edge of the radio-ulnar joint (Fig. 355). 



The displacement, symptoms and treatment are the same 

 as in Colics' s fracture and it is quite possible that many cases 

 diagnosed as Colics' s fracture may be epiphyseal separations. 



FRACTURE OF THE LOWER END OF THE RADIUS WITH 

 DISPLACEMENT FORWARD. 



This fracture, though rare, occasionally occurs, and if 

 union has taken place the deformity is marked and the 

 injury is liable to be diagnosed as a luxation. It has been 

 particularly described by Dr. John B. Roberts ("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, ' ' Phila. , 1897). On account of the difficulties in diag- 

 nosis it is well to examine its anatomical peculiarities. 



Displacement. The lower fragment is tilted forward 

 toward the palmar surface of the wrist, carrying the radial 

 side of the hand with it (Fig. 356). 



Signs. The line of the radius can be followed and 

 felt to curve at its lower portion toward the palmar surface. 

 The hand descending with the displaced fragment causes a 

 groove to appear across the dorsum from one styloid process to the other. The 

 dorsal surface of the lower part of the forearm is on a higher plane than that of the 

 carpus. As the hand is lower than normal this causes the lower end of the ulna to 



FIG. 355. Epiphyses of the 

 lower ends of the radius and 

 ulna; union occurs with the 

 shaft of the bones at about the 

 2oth year. 



FIG. 3 56. Fracture of the lower end of the radius with displacement of the lower fragment toward the palmar 

 surface. (Sketch, by the author, of a specimen in the Mutter Museum of the Philadelphia College of Physicians.) 



project much higher than it should. On account of the tension of the extensor carpi 

 radialis longior and brevior the hand is held level with the forearm and does not 

 droop as in Colics' s fracture. Displacement to the radial side may or may not be 

 marked. 



FRACTURE OF THE LOWER END OF THE ULNA. 



Previous to the use of the X-rays for diagnostic purposes, fracture of the lower 

 end of the ulna was considered extremely rare. Fractures of the ulna above the 

 head resemble practically those of the shaft. 



Fracture of the styloid process was observed by D. H. Agnew in one case which 

 was followed by deformity. Inasmuch as the deep fascia slides over the ulna it 

 is readily seen that if it is perforated one or other of the fragments may be caught in 

 the rent. This is probably the explanation of the deformity which occurred in 

 Agnew' s case. He advised treatment with the hand bent toward the ulnar side to 

 relax the extensor carpi ulnaris tendon. Fracture of the styloid process of the ulna 

 has been shown by the X-rays to be a more frequent accompaniment of Colics' s 

 fracture than was formerly thought to be the case, it tends to favor displacement 

 of the hand toward the radial side. 



