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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    badly contused. In some cases the line of fracture is such as to open into the inferior radio-ulnar articular cavity, producing laceration of its synovial sac and hemorrhage into it. In those severe cases in which comminution of the lower fragment has occurred, or more or less complete dislocation of the ulna, laceration of the synovial sac and hemorrhage into its cavity are important and inevitable complications. By the displacement of the fragments, as described, the fibrous sheaths and synovial envelopes both of the fle.Kor tendons in front, and of the extensor tendons behind, are injured. In front, the projection of the ragged edge of the upper fragment into the midst of the fle.xor tendons affords a fruitful source of injury to them; behind, the violent stripping up and continued tension of the periosteum is an injury done to the floor of all the tendon-sheaths, into the formation of which it directly enters. The fracture of the bone is thus both preceded and followed by a severe sprain to the joint. The sum of the injuries inflicted pre- sents a sprain of the most aggravated description. Is it possible to harmonize the treatment which the sprain demands with that called for by the broken bone ? If not, which should have the preference—the sprain or the fracture ? The rational treatment of sprain of the wrist has already been fully discussed. It was then stated that of wrist-joint injuries a wider range than had hitherto been accepted would be found to present sprain as the chief condition to be treated. Thus far it has been demonstrated that in all cases of fracture of the radius near the wrist-joint sprain exists as an important condition to be recognized. To decide upon its relative im- portance in determining the treatment to be adopted, requires next a consideration of the fracture. Fractures at the lower end of the radius may be divided into two distinct classes, viz.: those without displacement, and those with displace- ment of the fragments. This distinction is clear and important. The first class is likely to pass unrecognized—to be called a sprain, and to be treated as such. Immediately upon the recovery of the hand from the over-extension which it had sustained, the corresponding sur- faces of the fragments fall together where they are held by the weight of the hand as it is held prone. Upon the dorsum they are firmly joined to each other by the untorn periosteum. The line of fracture is trans- verse, and the apposed surfaces are broad, so that there is no tendency to displacement; force from without is necessary to make displacement possible. The conditions of the parts are favorable to rapid union. The sole indications for treatment presented by this class of cases are simply: 1st. That the wrist be supported in the prone position with the hand hanging loosely—thus maintaining the fragments in apposition.