284 The Radius and Ulna 



As the upper fragment cannot be influenced by pad or splint, the 

 surgeon must direct his attention to the shaft-fragment, bringing it 

 into the best position by flexing the fore-arm and supinating it, so 

 as to relax the biceps. 



When botb bones are broken, say at about the middle of the 

 fore-arm, the limb must not be put up with the hand either pronated 

 or half-pronated, as in that position the radius closely overlies the 

 ulna and there is risk of the four broken ends being solidly cemented 

 together with new bone. When the fore-arm is supinated the bones 

 are far apart ; therefore, as a practical surgeon once remarked, ' you 

 must arrange the limb so that the patient could spit into his hand.' 

 That is, the elbow is flexed so as to relax the biceps, whilst the fore- 

 arm is supinated and raised in a wide sling. 



In dealing with a fracture in the fore-arm, the bandages must not 

 be tight, lest the superficial veins be compressed which easily hap- 

 pens or lest the circulation through the arteries themselves becomes 

 arrested, and pressure-sores or extensive gangrene supervene. 



Fracture of the ulna. As the result of direct violence or muscular 

 action the olccranon process may be broken off. The separation does 

 not take place through the epiphyseal cartilage, as this is a mere shell 

 of bone at the top of the process, but through the narrow part halfway 

 down the great sigmoid cavity. Sometimes the detached piece is 

 dragged up by the triceps, but at other times, when the surrounding 

 fibrous tissue is not much torn, there may be no displacement whatever. 

 The fracture is, of course, into the joint, and is occasionally fallowed by 

 arthritis and ankylosis. The union may be only of fibrous tissue, but, 

 to secure the best chance of solid repair, the elbow must be kept on 

 a straight splint for three weeks, so that there may be no dragging by 

 the triceps. 



When a bone is broken in a synovial cavity, as in the case of the 

 olecranon process, the patella, and the neck of the femur, synovial 

 fluid bathes the fractured surfaces and often prevents their osseous re- 

 union. Non-union of the olecranon may leave the arm comparatively 

 useless, the fragment being drawn up the arm by the triceps, and the 

 power of extension being seriously interfered with. To remedy this 

 defect the joint may be laid open from behind, the surfaces of bone 

 freshened up, and the loose piece of the olecranon brought down and 

 fixed by wire sutures. 



The coronoid process may be broken off in backward dislocation of 

 the bones of the fore-arm, or it may possibly be detached and drawn 

 up by the energetic action of the brachialis anticus. Like the last 

 injury, it is a fracture into the joint. The elbow has to be fixed by a 

 rectangular splint for three weeks. In this way the brachialis anticus 

 is kept in perfect rest, and the broken surfaces are approximated to 

 the utmost degree attainable. 



Amputation in the fore -arm may be performed in the upper, 



