Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
As there is no tendency to re-displacement and no risk of non-union,
no retentive apparatus is required, but, if it adds to the patient's
sense of security, a bandage or a poroplastic wristlet may be applied.
In severe cases, however, anterior and posterior splints, similar to
those used for fracture of both bones of the forearm, or a dorsal
splint padded so as to flex the wrist to an angle of 45°, but somewhat
narrower, may be employed. The hand and forearm are in any case
supported in a sling.
To avoid the stiffness that is liable to follow, massage and movement
of the wrist and fingers should be carried out from the first, the
range of movement being gradually increased until the function of the
joints is perfectly restored. If splints are used, they should be
discarded in a week, and the patient is then encouraged to use the
wrist freely.
The various special splints recommended for the treatment of Colles'
fracture, such as Carr's, Gordon's, the "pistol splint," and many
others, are all designed to correct the deformity as well as to
control the fragments. It has already been pointed out that if
reduction is complete there is no deformity to correct, and if it is
not complete the deformity cannot be corrected by any form of splint.
_Unreduced Colles' Fracture._--When union has been allowed to take
place without the displacement having been reduced, an unsightly
deformity results. In young subjects whose occupation is likely to be
interfered with, and in women for æsthetic reasons, the fracture is
reproduced and the displacement of the lower fragment corrected. This
is conveniently done by means of Jones' wrench, which grasps the
distal fragment and affords sufficient leverage to break the bone.
#Chauffeur's Fracture.#--A fracture of the lower end of the radius
frequently occurs from the recoil of the crank, "by back firing," in
starting the engine of a motor-car. The injury may be produced either
by direct violence, the handle as it recoils striking the forearm, or
by indirect violence, from forcible hyper-extension of the hand while
grasping the handle. The fracture may pass transversely through the
lower end of the radius, as in Colles' fracture, but is more often met
with two or three inches above the wrist (Fig. 46). It is treated on
the same lines as Colles' fracture.
[Illustration: FIG. 46.--Radiogram of Chauffeur's Fracture.]
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