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. Velpean 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. Cones 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 extended than before ; the pain disappears, and in about a month after the fracture has occured, if judicious treatment be adopted, the union of the fragments is so perfect, that the passive motion to restore the joints to their primitive suppleness may be commenced.
Notwithstanding, therefore, the opinions of Dupuytren, Diday, &c., &c., we think that, as a general rule, in the case of Colles' fracture the prognosis is favourable.
It may be otherwise, if the styloid process of the radius be elevated much above its natural level, if the hand has quitted, par tially, the lower end of the ulna, so as to be carried "par un mouvement de totalite " outwards, and if the case has not been early recognised.
Anatomical characters of the Fracture. — On dissection, it will be found that the hard swelling which occupies the back part of the hand and wrist, is caused by the displacement backwards of the lower fragment of the radius, and the carpus carried with it in this direction. As a consequence of the altered direction of the radius, we find that the aspect of the carpal articular surface of this bone is altered, and instead of being directed, as it normally is *, downwards and somewhat forwards, it is now directed downwards and backwards (fig. 933.) ; the carpus and metacarpus retaining their connexion with the broken radius must always thus follow this bone in its derange ments, and cause the characteristic dorsal convexity above alluded to. The change of direction of the articular surface of the radius is well shown by measuring the length of the broken radius in these cases, both on the palmar and dorsal aspect of this bone longi tudinally, when it will be found that in Colles' fracture, the posterior measurement is several lines less than the anterior, which is exactly the reverse of what this measurement normally should be.
We dwell upon this abnormal obliquity of the lower articular surface of the radius, for in the treatment of this injury it should be our principal aim to remedy this obliquity, and, as it were, reverse it, and thus make the aspect of the articular surface look as it should normally do, downwards and forwards.
The change of direction of the articular surface is caused by the extensor muscles of the carpus, and of the thumb, and by their tendons, which pass along the posterior surface of the radius in sheaths, firmly con nected with the inferior extremity of this bone, to which deviation in the direction of the lower fragment the action of the supinator longus muscle and its tendons may also some what contribute.