Reason vs. tradition in the treatment of certain injuries to the wrist-joint / by L.S. Pilcher.

  • Pilcher, Lewis Stephen, 1845-1934.
Date:
[between 1870 and 1879?]
Catalogue details

Licence: Public Domain Mark

Credit: Reason vs. tradition in the treatment of certain injuries to the wrist-joint / by L.S. Pilcher. 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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    its direction and power, the strength and mechanical relations of the parts upon which it is expended, are the factors to be considered. The specimen which I now show you, the result of the last experi- ment, illustrates the conditions presented by the radial fragments in the more severe forms of this injury. A new point of motion has been established. The lower fragment of the radius is now virtually a part of the carpus, with which it moves, and by which it is carried backwards. At its inner border it is still tied to the ulna by the triangular fibro-cartilage and by the radio-ulnar ligaments ; at its outer border, being less restrained, the fragment has been displaced to a greater extent than at its inner, as the result of which a decided inclination to the radial side has been im- pressed upon the entire hand and wrist. The upper fragment, driven downward and forward, has become entangled in the lower near its palmar margin. The impaction is but slight, and disentanglement is easy when the attempts are properly made. The lower fragment is a broad thin shell of bone. If the upper fragment is driven into it with much force, its comminution is inevitable. That this sometimes occurs post-mortem examinations have repeatedly demonstrated. Examination of the periosteum covering the back of the lower portion of the radius, shows it a very thick and strong membrane. It is rein- forced by fibres prolonged from the posterior ligament of the wrist, and from the posterior annular ligament, by blending with which the canals are formed for the passage of the extensor tendons of the wrist and hand. By this blending of membrane, ligament and fascia, the posterior envel- ope of the radius at this point is converted into a thick, dense and strong aponeurosis, which, in the backward movement of the lower frag- ment in the production of the injury under consideration, is not torn through, but is simply stripped up from the back of the upper fragment, to a greater or less extent, according to the amount of dis- placement of the lower fragment. Such you see to have been the result in the wrist, which is now the subject of experiment. Such has been invariably the result in every experiment which I have made—a half dozen of the preparations saved from which I herewith present for ex- amination. The relation of the parts has now become such as is illus- trated by diagram 4, in which this adventitious periosteal ligament is rep- resented. The recognition of this strong aponeurotic band firmly grasping the