Signs.---The deformity is very peculiar (Fig. 39). The radius being broken, the support on the thumb side is removed and the forearm muscles so act on the hand as to pull it down to that side. As a result of this the skin is stretched on the inner side, and the projection—styloid process- - of the bone on the inside of the wrist joint is very prominent, the stretching of the skin over it causing the patient to complain of pain there. This must not cause the attention to be diverted from the real place of the injury, which is on the outside. The lower fragment rides obliquely on the upper and produces a lump on the back of the forearm, and this again causes a sudden hollow in front between the hand and forearm. The patient cannot turn hie wrist to lay the hand either palm downward or upwards. When the displacement has been reduced crepitation can be made out. The ulna is of usual length, but measurement shows the radius to be shortened.
Treatment.—To reduce the fracture support the forearm below the place of fracture with one band; with the other grasp the hand of the patient as is done in "shaking hands," and pull the band from the position of being drawn to wards the radial or thumb side towards the ulnar or inside. A considerable force is fre quently necessary to do this. The hand is pulled down towards the supporting hand of the oper ator, which acts as a fulcrum for the movement. As soon as the fracture has been reduced the deformity disappears. The best splint for re taining the bone in its proper position is the " pistol splint," so called from its appearance. It has a long straight part which should reach from the elbow to the wrist, and as broad as the broadest part of the forearm; it has also a part called the handle (a, Fig. 40), which should be as long as the distance between the wrist and tips of the fingers, and is directed down wards, forming an angle with the long portion equal to half a right angle. It is usually made of wood. To apply it, bandage the fingers and hand, pad the splint with cotton-wool, and then with a roller bandage fix the handle of the splint to the back of the hand, that is, on the outside, the hand being held thumb side up wards. When it has been fastened on so, the long portion of the splint is out of line with the forearm, projecting below it. Bring the long portion up to the line of the forearm, applying it close to the back of the arm. By this move ment the handle is made to carry the hand downwards towards the ulnar side, aiding iu the setting of the fracture, and retaining the ends of the bone in position. Another splint
is then placed inside. It should be moulded out of pasteboard, gutta-percha, or other mould able material, and should reach from the elbow to the wrist only. Fix the whole by means of a bandage from the fingers to the elbow. (See Fig. 41.) The trouble from the wrist joint is very great, owing to the great risk of stiffness resulting. The fracture will mend in a few weeks if pro perly put up; but it may be months before the wrist regains its function, if it ever thoroughly does so. Therefore in about three weeks in a young, and four in an old, patient, the wrist and joints of the fingers should be moved. with liniments will also help to re store the function.
Fractures of the Bones of the Wrist (Carpus) may occur from direct violence, such as the passing of a wheel over the hand, but the deformity is not marked owing to the small ness of the bones and their numerous connec tions. There will be pain, swelling, and on handling the fingers may detect grating (crepi tation).
Treatment.—Keep the wrist at rest by bind ing on the palm side a splint well padded. With the splint on the palm side, cold lotions, hot cloths, &c., may be applied on the back of the hand to keep down inflammation.
Fractures of the Bones of the Palm of the Hand (Metacarpus) are not 'infrequently due to striking a blow with the closed fist.
The Signs are movement of the fragments and grating. Displacement is not so common here, but it may occur, the head of the bone sinking down towards the palm, and a projec tion being formed on the back of time hand.
The Treatment recommended by Sir Astley Cooper consists in causing the patient to grasp a large ball and then binding a roller bandage round the whole.
Fractures of the Bones of the Fingers.
(Phalanges).—These bones are often broken, usually with a wound or severe bruising. Some times the wounding is so severe that amputation is necessary. Every effort should be made to save a finger; and special pains ought to be taken with the thumb and forefinger.
Treatment.—Apply a thin wooden splint, lightly padded with wool, to the front of the broken finger, and secure with a narrow bandage. In about three weeks begin to move the joints to avoid stiffness of joints becoming permanent. If serious wounds exist the dressings will re quire to be renewed every two or three days. This should be done, if possible, without mov ing the splint. A moulded splint of gutta percha or pasteboard is very comfortable.