FRACTURES OF THE SHAFT OF ONE OR BOTH I3oNEs.—Fracture is usually in the middle or lower third of the forearm, and the radius is usually fractured at a higher level than the ulna. Fracture of a single bone is most frequently due to direct fracture of both bones to indirect violence. Green-stick fractures are more common in the radius than in any other bone. Displacement in any direction may occur, and, if unreduced, is of spe cial importance as affecting the rotation of the forearm. A peculiar displacement is that of supination of the upper frag ment of the radius by the biceps when the bone is broken above the insertion of the pronator teres. According to most authors, unless the limb, in such case, is immobilized in extreme supina tion a permanent loss of that motion will result. Practically, however, the im pairment to supination when the limb is kept in the usual semipronated position is unimportant. Of far greater impor tance is the total loss or rotation that follows fusion of the two bones even when a lateral enarthrosis appears in the callus, as is rarely the case. The points that favor such a fusion are: (1) persistent displacement of the bones toward each other, (2) excessive callus from insufficient immobilization or im perfect reduction, and (3) the rare oc currence of fracture in both the bones at the same level.
In fractures of a single bone the dis placement is usually slight, and the di agnosis may be difficult. A point of local tenderness may be found with either crepitus, false motion, or irregu larity of the surface of the bone. In
fractures of the ulna. alone the head of the radius is often dislocated forward and upward.
TREATMENT.—Reduction by traction and local pressure, special attention be ing paid to the correction of any dis placement of the bones toward each other, forcing them apart by deep press ure with the finger-tips on the front and back of the forearm. Green-stick fractures must be reduced by forcible bending, even completing the fracture, if necessary. Circular constriction of the limb should never be applied, for this is a most fruitful source of gangrene. The best splint is made of two well padded boards a little broader than the forearm, the anterior one to extend from the elbow to the roots of the fingers (a roller bandage in the palm will prove grateful) and the posterior one from el bow to wrist. These are retained snugly by adhesive plaster strips, thus forcing the muscles between the bones. Angu lar deformity is avoided by slinging, not the forearm alone, not the hand alone, but both, comfortably and in the same palm. Such a sling also immobilizes•the elbow: an essential to the treatment. Pressure of the anterior splint on the brachial artery at the elbow and press ure on the bony points must be avoided. At the end of two or three weeks a plas ter splint may be substituted for the wooden one, and in any case daily exer cise of the fingers must be insisted on after the tenth day. Firm union should occur in a month, but delayed union is quite frequent.