WRIST-JOINT (ABNORMAL ANATOIIY\ 



skin the tense cord, and perceive that it can 

 be depressed even to the posterior surface of 

 the radius, from which it had been manifestly 

 elevated. This last is a test upon which 

 Velpeau specially relies. 



Upon the subject of Diagnosis of this 

 fracture of the carpal end of the radius, 

 Dr. Colics remarks, "the facility with which 

 the surgeon can move the ulna backwards 

 and forwards, docs not furnish him with any 

 useful help in his diagnosis as to the true 

 notion of the injury. Moreover, when he 

 moves his fingers along the anterior surface of 

 the radius, he finds it more full and prominent 

 than is natural ; a similar examination of the 

 posterior surface of this bone, induces him to 

 think that a depression exists about an inch 

 and one half above its carpal extremity. He 

 now may expect to find satisfactory proofs of 

 a fracture of the radius at this spot. For 

 this purpose he attempts to move the broken 

 pieces of the bone in opposite directions, but, 

 the patient is by this examination subjected 

 to considerable pain, yet neither crepitus, nor 

 a yielding of the bone at the seat of fracture, 

 nor any other positive evidence of the ex- 

 istence of such an injury is thereby obtained. 

 At last," adds Dr. Colles, " after many un- 

 successful trials, I hit upon the following 

 simple method of examination, by which I 

 was enabled to ascertain that the symptoms 

 above enumerated actually arose from a frac- 

 ture of the lower extremity of the radius 

 let the surgeon apply the fingers of one 

 hand to the seat of the suspected fracture, 

 and locking the other hand in that of the 

 patient, make a moderate extension, until he 

 observes the limb restored to its natural form. 

 As soon as this is affected, let him move the 

 patient's hand backward and forward, and he 

 will, at every such attempt, be sensible to a 

 yielding of the fractured end of the bone, and 

 this to such a degree as to remove all doubt 

 from his mind." 



I have already stated that sometimes the 

 fracture may exist without being accompanied 

 by any appreciable displacement of the bones. 

 The patient complains of a severe pain in the 

 region of the wrist, when pressure is made 

 on the broken part, and also when the fore- 

 arm is moved. These are the only symptoms 

 which exist, (if we except a slight swelling, 

 particularly observable on the anterior surface 

 of the wrist,) so that one would be tempted 

 to believe that there was only a simple sprain 

 existing. If, however, we make pressure on 

 the line of the articulation, we do not cause 

 the patient any pain, which we should do, if 

 the symptoms arose from a sprain, while if 

 the same degree of pressure be made a few 

 lines above the joint, the pain is very severely 

 felt. Now, if we place a thumb on the radius 

 behind, in the presumed seat of fracture, and 

 make the effort to bend the wrist at this part, 

 so as it were to make the forearm here form 

 an angle on itself, salient anteriorly ; if the 

 angle be thus formed, we hereby obtain a 

 pathognomonic sign of the fracture ; and a 

 comparison of the two wrists submitted 



1519 



equally to this experiment, puts the matter 

 beyond all doubt.* 



Fractures of the lower extremity of the 

 radius are generally looked upon as serious 

 injuries. If this fracture has been mistaken 

 for a sprain, or luxation, or abandoned to 

 nature, according to Dupuytren, very serious 

 changes ensue. " The forearm, in the region 

 of the wrist, instead of presenting a surface 

 flattened anteriorly, will assume a cylindroidal 

 form. The movement of pronation and 

 supination will be lost, an cedematous swell- 

 ing of the soft parts will continue ; the arti- 

 culation remains immovable for a consi- 

 derable time, and, if a rupture of the lateral 

 ligament of the inferior radio-cubital articula- 

 tion, or fracture of the styloid process of the 

 ulna be superadded to the fracture of the 

 lower extremity of the radius, we may see 

 continue for life the abnormal mobility of the 

 two bones on each other." Mr. Diday, of 

 Paris, has gone further, and asserted that 

 these consequences of fracture of the radius, 

 above alluded to, are often observed, in spite 

 of all kinds of treatment, and of bandages, 

 which modern surgery has suggested. 



In making an estimate, as to the amount of 

 evil resulting from the fracture of the lower 

 extremity of the radius and its usual con- 

 sequences, we find authors differ. Velpeau 

 would seem to attribute many of the evils 

 alluded to by Dupuytren rather to improper 

 bandages, and the "manner of treating the 

 injury, than to anything in the nature of the 

 accident itself. 



Although written so many years ago, the 

 opinion of Dr. Colles, as to the prognosis in 

 these cases, seems to us nearer the truth than 

 any of the above mentioned conflicting ob- 

 servations of the authors alluded to. 



Dr. Colles remarks, " that should the case 

 be treated as a case of sprain, and the fracture 

 left unreduced, the practitioner will find, after 

 a lapse of time, sufficient for removing similar 

 swellings, that the deformity is undiminished. 

 By such mistakes the patient is doomed to en- 

 dure for many months considerable stiffness, 

 and lameness of the limb, accompanied by 

 severe pains, in attempting to bend the hand 

 and fingers ; one consolation only remains, the 

 limb will, at some future period, again enjoy 

 perfect freedom in all its motions, and be 

 completely exempt from pain, the deformity 

 will, however, remain undiminished through 

 life." 



Upon the whole, then, we may safely say, 

 that when the fracture we have been describing 

 has nothing unusual in it, and is only accom- 

 panied with the ordinary displacement back- 

 wards of the inferior fragment, that the case 

 generally proceeds favourably. 



If the true nature of the accident has been 

 early recognised, and proper and sufficient 

 extension made of the forearm, the peculiar 

 characteristic curve disappears, not to return ; 

 the fingers are found to be much more free 

 in their movements, and can be more fully 



* See Colles and Malgaigne. 



