Treatment is a matter of some difficulty, be cause of the impossibility of overcoming the ac tion of the muscle and keeping the process down in position; secondly, because union is by liga ment and not by bone. The only way would be to keep the arm quite straight by a splint; but this is exceedingly irksome. The patient must make up his mind to get only a moderately satisfactory result, which will leave his arm not so powerful as before. The simplest method of treatment is to fix the arm at an open angle, to mould a splint for the back of the elbow, cut ting in it a hole to admit the process, the edges of the hole being carefully rounded. Put this splint on, keeping the olecranon down in posi tion as well as possible by means of the hole, and fix with a starch bandage (see BANDAGES) from the fingers up to the elbow.
Fracture of both Bones of Forearm at the centre of the shafts happens by direct vio lence. It is easily recognized, all the signs of fracture being easily made out. The bones are displaced towards the middle line of the arm, that is, they approach one another.
When only one bone is broken, the other one acts as a splint and prevents displacement. The way to detect the fracture in this case is to follow the outline of the bones by running the fingers firmly down from the elbow to the wrist. Examine one bone at a time. When the fingers conic over the seat of fracture, the bone is felt to yield under the fingers, there is grating, and the patient feels pain.
Treatment.—Whether both bones be broken or only one the treatment is the same. Reduce the fracture by pulling on the wrist while an assistant keeps the upper fragment fixed.
Then apply both outside and inside splints as broad as the arm, made of wood, or pasteboard, or similar material, and padded with cotton wool. The splints should fix the wrist joint, but leave the elbow joint free. When the splints are being applied the hand should be held so that the thumb points directly upwards. Care ought to be taken that when the arm is bent the inside splint does not press hard up into the elbow, as it might compress blood vessels and do harm. The splints should be secured by three straps, and then by a roller bandage from the points of the fingers up to the elbow (Fig. 38). The risk is that union may take place, not only between the ends of each bone, but also between the bones themselves, so that turning the palm of the hand upwards or down wards is afterwards prevented. To avoid this a pad or ridge of cotton-wool is recommended to be placed down the length of the arm, under the inside splint, to keep the two bones apart. There
is danger of pressing too much ou the blood-ves sels by this, and it is, therefore, better to omit it. After bandaging put the arm in a sling. No bandaging is here required previous to the appli cation of the splint. For this fracture splints are readily furnished out of bandboxes and similar material, the thin wood torn from which is cut to the size and shape required, and then steeped in hot water till it can be moulded, several layers thick, to the limb.
Fracture of both Bones close to the Wrist Joint may, from the nature of the de formity, be mistaken for dislocation at the wrist joint, though it must be noticed that simple dis location of the wrist joint is e.vtremely rare. In fracture the wrist bones with the lower frag ments of the radius and ulna are shot up either in front of or behind the upper fragments, while in dislocation the wrist bones alone are carried up in front of or behind the forearm. The land marks are the projecting processes—styloid pro cesses—of the radius and ulna, on the outer and inner side. In fracture these are seen standing out from the sides, and bone can be detected beyond them, the wrist bones being still em braced by them. Next measure the forearm bones from the point of the elbow downwards to the projecting ends, and compare with the mea surements of the opposite side. In fracture the measurement is less than the usual. Measure also from the knuckle of the middle finger to the upper end of the lower fragment. In frac ture it is greater than the ordinary measure ment from the same point to the lower end of the forearm bones. The other signs of increased movement, grating, &c., are present in fracture.
The Treatment is the same as that already described for fractures of the shaft, viz. two straight splints.
Fracture of the Lower End of the Radius (p. 62)—COLLES' FRACTURE.—This is a fracture of very common occurrence. Aboht one-third of the total number of fractures occurring in the body is of this kind. It is specially frequent in old people, and is oftenest caused in them by slipping on the street and falling on the hand, palm downwards, which has been put out to save them. It is a fracture of the radius, which is on the outer or thumb side of the forearm, and occurs about an inch above the wrist joint. It is called Colles' fracture, because it was first described by Dr. Colles of Dublin in 1814. It deserves special notice, not only because of its frequency, but also because of its liability to be mistaken for dislocation of the wrist.