Surgical reprints. 1st series / Robert Jones.

  • Jones, Robert, 1857-1933.
Date:
[1888?]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical reprints. 1st series / Robert Jones. Source: Wellcome Collection.

    15/98 (page 7)
    my heart I envy the diagnostic skill of those authorities who learnedly tell us that they can detect the position of the line of fracture in the living subject to. within a quarter of an inch. I have given over the attempt long since in despair, Mr Lucas finds fault with the authors of nearly all our text- books for speaking of a prominence of the styloid process of the ulna (which is so often broken), instead of a prominence of the lower end of the ulna. It is more correct, I think, to speak of the abduction of the hand, as the ulna is a fixed point. Some authors go so far as to allude to the “ luxation ” of the ulna. This is of course an error. The degree of mobility is very trivial in this form of accident. In eighty-five of my cases there was no movement of supination or pronation. In seven there was this motion to a limited extent. All the seven cases were recent, and in not one was the deformity extreme. In some cases, on the contrary, where the deformity was equally slight, the hand admitted of no movement. In testing this, it is important to fix the elbow, as there is in most cases apparent supination and pronation due to action at the shoulder-joint. In five I found very free movement of the fingers, in ten no movenient whatever. The rest fluctuated between these extremes. In unreduced cases of at least a week’s standing movement is generally present to a varying extent. Pain is a prominent symptom, although I do not think it greater than in other fractures of the upper extremity. Twenty- three complained of most pain over the.iniier side of the wrist. This is referred to by Mr Lucas, who, in dissecting an old case, discovered the dorsal branch of the ulnar nerve stretched, and angularly displaced, by the abducted hand. This may of course sometimes account for it, but I very much doubt that it generally does. We know that after falls on the palm, where a Colles has not resulted, pain is felt over the internal lateral liga- ment, and whenever the joint is sprained pressure on this spot is accompanied by much suffering. The same is true in fractures of t le lower end of the radius without displacement. Twenty-nine complained of most pain over the seat of fracture in front; only