42 SURGERY. 



vity. A pad will be necessary in the axilla, and the same dressing 

 as the last. A new joint is formed, and the motions of the arm are 

 only partial. 



The shaft may be fractured at any point, and is easily recog- 

 nised by crepitation ; and when the fracture is just below the surgical 

 neck, the lower extremity of the upper fragment is drawn inwards 

 by the muscles inserted into the bicipital ridges, and the upper ex- 

 tremity o^ the lower fragment is drawn outwards by the deltoid 

 muscle. 



TreoXment. — The reduction is easy, and the extremities may be 

 retained in contact by four small splints placed around the arm, 

 and secured by a roller, which, as in all other instances of its use in 

 the upper extremity, must commence at the hand. The forearm 

 should be suspended in a sling. 



The condyles are fractured in various ways. Either condyle may 

 be fractured, most frequently the internal ; or, there may be a frac- 

 ture between the two condyles, and another separating them from the 

 shaft. These injuries ai-e distinguished from dislocation at the elbow 

 by mobility and crepitation. 



Treatme^it. — By a roller and two angular splints, (Physick's,) 

 reaching to the hand from the middle of the arm. The angle of 

 the splints must be changed to prevent anchylosis. Some deformity 

 and stiffness often remain. 



FRACTURE OF THE RADIUS AND ULNA. 



When both bones of the forearm are fractured at 6nce, or when 

 either bone is fractured near the middle, there is but little difficulty 

 in the diagnosis, being easily recognised by the ordinary signs of 

 fractures, such as pain, crepitus, swelling, and uselessness of the 

 limb. 



Treatment. — The great object is to preserve the interosseous 

 space ; for, if the fragments unite at an angle, supination and prona- 

 tion will be prevented. The fracture is readily reduced by slight 

 extension, and then the muscles shonld be pressed into the interos- 

 seous space, in order to separate the two bones. 



Two splints, well padded on the inside, reaching from the elbow 

 to the fingers, should be applied, and retained by a roller. The arm 

 must be kept in a position between supination and pronation, and 

 supported by a sling ; after a week or two pasteboard splints, or a 

 starch bandage may be substituted. 



The RADIUS is more frequently fractured than the ulna, on account 

 of its articulating with the, carpus, and thus receiving the weight of 

 the body in falls, &c. When fractured near the middle there is but 

 little deformity, the ulna acting as a splint. 



The fieck of the radius is but rarely fractured, and the accident is 

 difficult to recognise, especially when the muscles covering it are 



