44 SURGERY, 



fear of anchylosis, and the loss of the pulley-like motion of the ex- 

 tensor tendons on the back of the radius. 



The ULNA is most frequently fractured below the middle of the 

 shaft. The lower fragment approximates the radius by the action 

 of the pronator quadratus, and the- other usual symptoms of fracture 

 are evident. 



The olecranon process is often fractured by sudden violence, or 

 muscular action. The fragment is drawn up upon the back of the 

 arm by the triceps muscle, and the deformity is increased by flexion. 

 The union is usually ligamentous. (Fig. 4.) 



The caronoid process is rarely fractured, and usually by inordi- 

 nate musculai: action of the brachialis anticus muscle, whose tendon 

 is inserted in front of the base of this process. Dislocation back- 

 wards by the action of the triceps may result. The union will be 

 ligamentous. (Fig. 5.) 



7/-ea^??2€??^.— Fractures of the shaft are to be treated by two 

 splints and compresses, as are those of the radius. Fracture of the 

 olecranon is to be treated by extending the elbow, placing a small 

 splint in front of the joint, and securing it by a roller. The coronoid 

 is to be treated by flexing the elbow, applying a roller to relax^ the 

 muscles and prevent their action, and keeping the forearm in a 

 sling. 



FRACTURE OF THE CARPUS, METACARPUS, AND PHALANGES. 



The bones of the carpus are seldom fractured. The injury is 

 usually a compound one, and produced by direct force. 



The metacarpal bones are subject to simple fracture, which is 

 easily recognised by pain, swelling, crepitus, &c. The treatment 

 consists of coaptation of the fragments, and retaining them by 

 means of two splints and interosseous pads, or compresses. 



The phalanges are liable to compound and simple fracture. 

 Simple fractures to be treated by two or four small splints, and a 

 narrow bandage ; when several fingers are broken, a curved splint 

 will be useful. 



FRACTURE OF THE FEMUR. 



The neck may be fractured within the capsule. This occurs most 

 frequently in old persons, and in females, on account of bony tex- 

 ture being more brittle in advanced life, and on account of the 

 anatomical character of the neck of the femur in women. The 

 accident may be produced by a slight fall, muscular contraction, 

 blows, &c. The head of the bone remains in the acetabulum ; the 

 lower fragment is drawn upwards by the muscles of the hip, and 

 the foot is everted, owing to the action of the rotator muscles. 

 The limb is shortened, the trochanter is one or two inches higher, 

 and flatter than its fellow ; there is pain, crepitus, and want of voluntary 



