86 Anatomy Applied to Medicine and Smgery. 



will be referred to again in connection with the diag- 

 nosis of dislocation at the wrist joint. These three varie- 

 ties of displacement occur simultaneously, are mechanical 

 rather than the result of muscular action, and account for 

 the peculiar deformity present in this fracture. The dis- 

 placement and rotation backwards cause the projection 

 posteriorly termed the "silver fork" deformity, while the 

 rotation outwards produces the inclination of the hand to 

 the radial side a characteristic symptom of Colics' frac- 

 ture. Occasionally, when the traumatism is very severe 

 the ligaments attached to the ulna, viz., the internal lateral, 

 the radio-ulnar and the inter-articular fibro-cartilage 

 are ruptured and the head of the ulna penetrates, and is 

 held by, the annular ligament, and, when this complication 

 exists, the ulna must first be reduced by extension and 

 partial circumduction of the hand before attempting to re- 

 duce the displaced lower fragment of the radius. The 

 knowledge of this triple displacement of the lower frag- 

 ment in Colics' fracture assists the surgeon in its reduc- 

 tion. An assistant makes extension by holding the pa- 

 tient's hand as though he were shaking hands with him, 

 and the surgeon, grasping the forearm with the fingers of 

 both hands presses the upper end of the displaced frag- 

 ment with both thumbs in such a manner as to mould it 

 downwards beneath the upper fragment, when, as a rule, 

 two straight splints will be all that is needed to hold the 

 fragments in position. Proper reduction is imperative, 

 and far more important than the style of splint employed, 

 and the neglect to secure it is, no doubt, chiefly responsible 

 for the deformed wrists that not infrequently follow 

 Colles' fracture. In all of these fractures of the radius, 

 the comparatively superficial situation of the head of the 

 bone in the muscular triangle behind the elbow joint is of 

 great assistance in the diagnosis, since, by feeling the head 



