31. The reduction of a fracture of the radius is effected in nearly
the manner already described for that of the two bones of the fore-arm
(10–13), except that, here, the extension must be less, because there
exists no displacement in a longitudinal direction (26).
To remove that which exists in a cross direction, an assistant whose
business it is to make extension, places the hand in a state of
adduction, for the purpose of removing the inferior fragment outwards.
This precept cannot be applied to much advantage, if the division exist
towards the upper end, on account of the interosseous ligament.
At the same time the surgeon endeavours to bring the ends of the bone
into perfect contact, by pushing them in a direction opposite to that
of their displacement; and when he has attained this end, he begins
the application of a bandage or apparatus the same as that already
described (19 and 20), with this difference, that as the ulna is here
sound, and performs, in relation to the fractured radius, the office of
a natural splint, it is unnecessary to place an artificial one between
the internal condyl of the humerus, and the styloid apophysis of the
ulna.
32. The consolidation or cure is here always more speedy than in the
preceding cases, where nature, with the same amount of means and
resources, has twice the quantum of labour to perform, and where she
supplies her deficiency of power, by the greater length of the time
which she employs. In general the bone is united by the twentieth or
twenty-fourth day.
33. When the fracture exists at the superior part of the radius, it is
essential, after the removal of the apparatus, to make the limb very
frequently perform all its natural motions. In such a case, indeed, the
parts sometimes swell, become stiff, and an anchylosis of the fore-arm
may be the consequence, as Ambrose Pare observes, in his book on
fractures, where he says he has seen many accidents of this kind. Galen
has remarked the same thing before him. The following case reported by
Jeo. Dol**, confirms the truth of it.
CASE II. Jane Rene was received into the Hotel-Dieu, in consequence of
a fracture of the upper extremity of the radius, produced by a fall
on that part, for which she was subjected to the treatment already
described (31). The apparatus being removed at the expiration of
twenty-five days, the consolidation was perceived to be complete.
The motions of pronation and supination were impracticable; those of
flexion and extension very much impeded. The patient was now ordered
to have the fore-arm moved daily, in these several directions, for
the space of an hour, and this space was even increased morning and
evening, notwithstanding the pains which, at first, accompanied the
exercise. On the eighth day pronation and supination could already
be performed in a small degree; they became more and more free, in
proportion as the exercise of the limb was longer continued; finally,
on the twenty-second day from the removal of the apparatus, the
patient was conducted, according to custom, to the amphitheatre, where
all the pupils witnessed the perfect freedom of the motions.
CASE III. A few days after this, a man, who had left the Hotel-Dieu
about eight months before, while under treatment for a similar
fracture, returned, to be the subject of a public consultation in
consequence of a different disease.
Desault, on interrogating him, learnt from him that the treatment for
the fracture had been continued at his own house (31), but that, when
the apparatus was removed, no motion had been impressed on the limb,
and that the surgeon had even kept it in a sling. The fore-arm was then
examined; it was half bent, constantly in a state of pronation, and
could not, by any force, be brought into a state of supination. The
motions of flexion and extension, were so limited as to be scarcely
sufficient for the common wants of the patient, who, under proper
treatment, might have been cured like the preceding one, as Desault
remarked to his pupils at the time.
34. The patient who was the subject of this second case, was sent
to the mineral springs, but derived no benefit from the use of the
waters. If this were a proper occasion, I could mention many instances
where this remedy, so highly spoken of by many physicians of the
present time, has had no effect, except to deprive the patient of more
efficacious means, by making him lose that time, during which exercise
frequently repeated, would have effected a cure, but which, coming too
late, could be of no avail.