ACCIDENT. — The principal lesions which the structure that compose the region of the wrist are liable to, are : 1st. Dislocations of the wrist and neigh bouring radio-ulnar articulations.
2nd. Dislocations of the bones of the carpus.
3rd. Fractures of the lower extremities of the bones of the forearm, in the immediate vicinity of the wrist-joint.
lst. Dislocations. — Dislocations and frac tures of the bones entering into the com position of the wrist-joint are two kinds of lesions, which for a long time have been confounded together, or mistaken for each other. Even in modern times authors have stated the wrist-joint to be liable to numerous luxations. Thus, Boyer, Petit, Mr. Samuel Cooper, &c. &c., entered into a de scription of the different dislocations of the wrist, as forwards, backwards, inwards, and outwards, complete and incomplete, just as Hippocrates and others, down to Celsus, had done.
Nevertheless, some moderns, at the head of whom we would place Dr. Colles of Dublin. Dupuytren, and Sir Benjamin Brodie, main tained that luxations of the wrist-joint from accident were either impossible, or, at all events, exceedingly rare, and expressed their opinion that authors had, under the erroneous name of dislocation, really described an accident now pretty generally believed to be a frac ture of the radius in the immediate vicinity of the wrist-joint, with displacement back wards of the carpus and hand.
Velpeau followed these, and not only de nied the reality of such an accident as simple dislocation of the wrist, but gave his reasons why he believed that no such accident could occur, observing, that the strong tendons of the flexor muscles of the forearm, bound down by the anterior annular ligament of the carpus, must render impossible any luxation of the bones of the forearm forwards at the wrist-joint, any forcible bending back wards of the hand, such as might, for example, be produced by a fall on the palm ; and, 2ndly, that the common and radial extensor (re strained as they are by the posterior annular ligament), oppose any luxation of the bones of the forearm backwards at the wrist during a movement which should produce an extreme flexion of the hand forwards.
Velpeau, however, admitted, that from ex periments he had made on the dead subject, he had learned that efforts of a different order, such as a forcible pulling, accompanied with a simultaneous bending of the hand, whether backwards or forwards, inwards or outwards, might break every tissue, and produce a lux ation without any fracture of the radius. Such
cases, he says, he believes will always be ac companied with a wound of the integuments, and are not to be looked upon as the simple dislocations we are now considering, nor should they, in his opinion, enter into the same category with them.
In support of the doctrine, that most, if not all, of the simple dislocations of the wrist, of the authors already alluded to, were really fractures of the lower extremity of the radius, we confess that one observation of Velpeau appears particularly strong, viz., that for the last thirty or forty years in which the question has been discussed, and the reality of the luxation disputed, no one has brought forward one instance which, rigidly examined, he would look upon as an incontestable exam ple of a simple luxation of the wrist-joint. He admits that the solitary case adduced by Voillemier is a very notable one, and de serving of attention, but that in his opinion, the question is still open as to whether a sim ple luxation of the wrist-joint can occur, without there being at the same time any lesion of the edges of the articular surfaces, or of the integuments.
We think we cannot do better than here give an abstract of this remarkable case, given by Voillemier.* " Levillain Louis, mt. 27, of a vigorous con stitution, on the 28th Sept. 1839, was ad mitted under the care of M. le Noris, into the thipital des Cliniques (Paris) ; at the moment of admission he was in a hopeless state, insensible ; the pupils largely dilated, the respiration stertorous. Amongst other lesions from which the patient had suf fered, in consequence of his having fallen into a court-yard from a window three stories high, to the ground, it was noticed specially that the left wrist-joint presented a very remarkable deformity, and of such a nature that Voille mier, prejudiced as he said he felt he was, that a luxation of the wrist was a great rarity, if not an impossibility, could not help saying to his colleague, M. Dumeril, present at the examination of the patient, that the case be fore them was one of dislocation of the wrist. Four hours after the admission of the patient into hospital he died.