Cases of stretching of the facial nerve for tic convulsif ; Cases of intussusception treated by operation ; Case of rare fracture of the radius / by Rickman J. Godlee.

  • Godlee, Rickman John, Sir, 1849-1925.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Cases of stretching of the facial nerve for tic convulsif ; Cases of intussusception treated by operation ; Case of rare fracture of the radius / by Rickman J. Godlee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    \ repeatedly tried both by the house-surgeon and myself, indi- vidually and together; and as it was clear that the lower end of the ulna was the cause of the difficulty I made an incision over it, an inch and quarter long, and at once came down upon the bare end of the bone, which lay immediately beneath the skiu. I then passed a blunt hook beneath the tendon of the flexor carpi ulnaris (and no doubt the ulnar artery as well) and endeavoured by pulling them aside whilst extension and counter-extension were made to put the bones back in position, but without avail. I then removed the styloid process only and repeated the attempt, but again with- out success, so the lower end of the bone was sawn off just above the level of the surface which articulates with the lesser sigmoid cavity of the radius; after doing this there was no difficulty in replacing the bones. The wound was stitched up and a drainage tube was inserted, and the usual antiseptic gauze dressings were applied, the limb being afterwards placed in two splints reaching from the knuckles to the elbow. The wound healed without suppuration; the stitches and the drainage tube were removed on the fourth day, and the patient was allowed to leave his bed. On August 4, ten days after the accident, the limb was placed in a plaster-of-Paris casing, in which a window was subsequently cut to allow of the dressing of the minute remaining sore, and the patient left the hospital. This was removed at the end of the sixth week, and passive motion was commenced. It will be seen now that there is a little deformity on the inner side owing to the absence of the lower end of the ulna, and that the movements of supination and extension are not quite so free as on the opposite side, but that beyond this the limb is as good as the other; in fact the patient himself con- siders that it is quite as useful; he is able to use it for exercise on the parallel and horizontal bars, as well as for all the ordinary employments of life, and the amount of movement appears to be improving with the daily forcible movement to which he has been told to subject it, but which till the end of November, when I impressed upon him the necessity for so doing, it appears was very imperfectly carried out. It may be necessary to remove the lower end of the ulna not only in rare cases such as this, but also as the result of disease; and it is therefore, I hope, not uninteresting to see how little the usefulness of the limb is impaired by such a proceeding. It should be added that the triangular fibro- cartilage had been torn across during the accident.