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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    The failure to recognize this, and to direct the manipulations for re- duction so as to meet the indications arising from it, has been the source of all the difficulties heretofore experienced in removing the deformity occasioned by severe cases of this injury. Granted that it is this which so persistently and firmly clasps the fragments together in a condition of pseudo-impaction, then this is the first obstacle to be overcome in secur- ing reduction. It might be torn across by sufficiently powerful exten- sion, and thus be overcome. There is a better and an easier way, how- ever. I take this wrist, which has been the subject of the experiment before you. It presents, strongly marked, the characteristic deformity, and illustrates the part played by the dorsal periosteal strip in question. (See diagram 5). By simply bending the hand and wrist backward, approx- imating the position in which the parts were when the displacement took place, the tense periosteum is relaxed. Slight extension now in the line of the forearm is sufficient to disentangle the rough surfaces of the fragments from each other. Moderate pressure upon the dorsum of the lower fragment causes it to fall into line. The weight of the hand is now sufficient to secure perfect apposition of the fragments; the peri- osteum again envelops closely the whole length of the radius; the tense inner fasciculus of the anterior ligament is completely relaxed; the radio- ulnar movements are free; the head of the ulna has ceased to project as if subluxated; all the parts have resumed their natural relations. Dr. Moore, in the paper already referred to, describes a plan of reduc- tion intended to meet the indications imagined by him to be present. His plan, circumduction of the hand with extension, has been proven practically to be of great value. To this I can testify from my own re- peated experience. Upon analyzing it, the fact is patent that its value has rested in the fact that among the movements contemplated by it are included the movements which have just been shown to be the only ones necessary to effect reduction of this fracture, however great the dis- placement. All else in the plan of Dr. Moore is surplusage. By the replacement of the fragments of the radius in their normal re- lations, the fracture has become one of the first class—with this differ- ence simply, that the sprain of the soft parts is much more aggravated. All the measures indicated as of value in overcoming the results of sprained wrist, elaborated and described in the first part of this treatise, are now of importance in the further treatment of this injrfry. Com- pression and support, by means of a bandage encircling the joint, is of value. The snug application of a strip of strong adhesive plaster, two inches wide, so as to grasp firmly the lower extremities of both radius and ulna, will restrict effusion, reinforce the radio-ulnar ligaments, and render more tolerable eff'orts at motion of the wrist-joint.