760 S U R 
ceive a distinct luxation of the radius yet claiming his assist¬ 
ance. And, as Delpech observes, the radius and ulna can 
only preserve their due relation to each other in dislocations 
of the elbow, when the external lateral ligament happens to 
break above its connection with the annular ligament of the 
radius. 
When extension is made, recent dislocations of the elbow 
are easily reduced. For this purpose, an assistant is to take 
hold of the arm above the joint and fix the humerus, while 
another assistant makes the requisite extension at the wrist in 
the axis of the displaced forearm. At the same time the 
surgeon is to promote the reduction by pressing the heads of 
the ulna and radius in the desirable direction. 
The arm should afterwards be kept in a sling; and if there 
be much swelling of the soft parts, venesection, leeches, cold 
washes, low diet, and purging, will be proper. In these 
cases, there is not much tendency to displacement again. 
The radius and ulna may be broken at their middle, or 
extreme portions; and the injury most frequently happens 
to the radius. The latter circumstance is accounted for by 
the different relations of these two bones to the hand, and 
by the naturally curved form of the radius. They are both 
most liable to be broken at their narrowest parts, and hence, 
when fractured together, the injury seldom happens at a 
parallel point of the two bones. In some instances, how¬ 
ever, the radius is broken at its lower end, and the ulna at 
its upper one. When the radius breaks, it is mostly from a 
fall on the hand, but, when the ulna alone suffers, or both 
bones are fractured together, it is generally in consequence 
of violence applied directly to the forearm. 
In fractures of the forearm, the fragments are generally 
displaced, both with regard to the diameter and direction of 
the injured bone. The ends of the fracture are mostly in¬ 
clined towards the centre of the limb. It is to be observed, 
however, that the upper portion of a broken ulna is not sus¬ 
ceptible of this kind of displacement, on account of the 
manner in which it is articulated with the humerus. When 
both bones are broken, the member is sometimes bent for¬ 
wards, or backwards. 
Fractures of the radius are easily detected; for, on endea¬ 
vouring to rotate the bone, or, in other words, to place the 
hand alternately in a prone and supine posture, a crepitus is 
immediately perceptible. When the two bones are broken, 
the nature of the accident is indicated both by the crepitus 
and the distortion of the forearm. Fractures of the ulna, 
especially when high up, are not always immediately ob¬ 
vious. However, if the surgeon make pressure on each side 
of the suspected point, with his thumbs alternately, he will 
generally distinguish a grating sensation. 
As the fragments do not pass over each other, scarcely 
any extension is necessary for their reduction ; but, the sur¬ 
geon must incline them away from the interosseous space by 
pressure gently exercised on the dorsal and palmar sides of 
the limb. 
During the treatment, the elbow is to be bent, and the 
hand put in the mid-state, between pronation and supina¬ 
tion ; that is to say, the palm of the hand is to face the 
patient’s breast. Only two splints are necessary; one is to 
be placed along the inside, the other along the outside of the 
forearm; and soft pads must be interposed between the skin 
and the splints. 
The olecranon may be broken by falls, or blows upon the 
elbow, or by the violent action of the triceps muscle; the 
injury may take place at various distances from the extre¬ 
mity of this process; the solution of continuity may be 
single; or the part may be broken into several pieces. In 
consequence of the action of the triceps and the effect of 
bending the elbow, the detached fragment of a broken ole¬ 
cranon would always be drawn up a considerable distance 
from the rest of the bone, -were it not for the aponeurosis, 
which is extended from the tendon of the triceps over the 
posterior surface of the olecranon; for, it mostly happens, 
that this tendinous expansion is not ruptured, or, at all 
events, not completely; and what remains entire has the 
S U R 
effect of limiting the separation of the fragment or frag¬ 
ments from the main part of the bone. 
The member having been slightly bent, a pad filled with 
tow, and thicker in its centre than at its ends, in order to fill 
up the hollow in front of the elbow, is to be laid along the 
forepart of the arm and forearm, and then a splint is to be 
put over it, and fixed (but not too tightly) with a common 
roller. When the inflammation of the soft parts is very 
considerable, I think the immediate use of the bandage and 
splint should be deferred for a few days, until the swelling 
has been diminished by leeches, venesection, cold applica¬ 
tions, and other antiphlogistic remedies. Were the fascia 
derived from the tendon of the triceps, entirely lacerated, 
and the fragment of bone drawn very far up the arm, it 
might be necessary to have recourse to a compress and band¬ 
age for hindering such retraction; but, in this case, the move¬ 
ments of the elbow after the cure would probably be some¬ 
what weak and imperfect. 
Fractures of the metacarpal bones, and fingers.'—The 
metacarpal bone of the little finger is said to be most fre¬ 
quently broken. In the treatment of fractures of the meta¬ 
carpal bones, the only object is to keep the adjacent joints 
perfectly motionless. 
Fractures of the carpus are, for the most part, produced by 
such extreme violence, as perfectly jams the limb and causes 
immediate amputation to be necessary. In milder cases, to 
extract splinters of bone, to keep the parts perfectly immove¬ 
able and reduce inflammation, is all that can be done. Dis¬ 
locations of the carpus are, of course from the slightness of 
the coverings of the bones at this part, easily detected ; and, 
in most instances, at first may be easily reduced by the ob¬ 
vious means of extension and pushing the displaced bones 
into their place. The same may be said of other disloca¬ 
tions of the hand, with the exception of luxation of the 
thumb, which is very difficult of reduction. 
The phalanges of the thumb are most liable to be dislo¬ 
cated backwards. In this case, the base of the phalanx glides 
backward behind the head of the first metacarpal bone, lace¬ 
rating the capsular ligament, stretching the tendons of the 
extensor muscles, and changing the direction of the lateral 
ligaments, without breaking them. 
The nature of the case may be known by the head of the 
first phalanx of the thumb projecting back, so as to form 
nearly a right angle with the metacarpal bone; by the tu¬ 
mour produced in front of the joint by the head of the latter 
bone; by the bent position of the second phalanx caused by 
the tense state of the tendon of the flexor longus pollicis; 
and by the impossibility of either bending or extending the 
first phalanx. 
Extension should be made, not however so as to bring the 
bpnes in a straight line, but so as to bring forward the 
phalanx in its distorted condition. The articular surface 
may now be pressed into contact, the bones straightened, 
and then the reduction effected. If this plan does not suc T 
ceed, a couching-needle may be introduced under the shin, 
so as to divide one of the lateral ligaments. 
SU'RGICAL, ndj. Pertaining to the art and skill of a 
su rgeo.n; chirurgical. 
SURGOOJA. See Sirgooja. 
SURGUT. See Sourgout. 
SU'RGY, adj. Rising in billows. 
Do public or domestic cares constrain 
This toilsome voyage o’er the surgy main ? Pope. 
SURHUYS-TERVEEN, a petty town of the Netherlands, 
in the province of Friesland, with 1100 inhabitants. 
SURIANA [so named by Plunder, in honour of Joseph 
Donat Surian, physician at Marseilles, who accompanied 
him in his travels], in Botany, a genus of the class decandria, 
order pentagynia, natural order of succulentae rosaceae. 
(juss .)—Generic Character. Calyx: perianth five-leaved; 
leaflets lanceolate, acuminate, permanent. Corolla: petals 
five, obovate, length of the calyx, spreading. Stamina: fi¬ 
laments ten, filiform, shorter than the corolla? anthers simple. 
Pistil: 
