Case of dislocated head of radius, successfully reduced two years and one month after the occurrence of the dislocation / [James Stark].

  • Stark, James
Date:
[1847]
Catalogue details

Licence: Public Domain Mark

Credit: Case of dislocated head of radius, successfully reduced two years and one month after the occurrence of the dislocation / [James Stark]. Source: Wellcome Collection.

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    Sir Astley Cooper relates, that during his extensive practice he had only seen six cases. Of these, four were unable to be reduced, though the most varied and violent efforts were used. The other two were reduced. In my own practice, only two cases of dislo- cation of the head of the radius forwards had previously been met with. In the first case, the woman fell over a window three sto- nies in height, and, besides other injuries, received a compound fracture of the condyles of the humerus, with displacement for- wards of the head of the radius. In consequence of the injury to the soft parts, and the fracture of the condyles, the head of the radius could not be retained zz situ, and when the cure was effected, the callus had formed a new socket for the head of the radius, and it was not considered prudent to interfere with it. From the head of the radius moving in a bony socket, the arm soon after- wards became quite strong, though it never could be bent so as to allow the fingers to touch the face; and the woman, by occu- pation a washerwoman, was able to prosecute her usual employ- ment. In the other case, the accident occurred from falling on the ice, alighting on the hand; and the reduction was easily effected by pulling by the hand, and bending the fore arm on the arm, when the head of the radius was brought to the edge of the articular surface of the humerus, at the same time pressing down the head of the radius with the thumbs. In the present case, the child was of a soft lax fibre, and as the arm was comparatively useless and weak, it was wasted or much softer, thinner, and less muscular than the sound arm. Provided, therefore, that the extension was applied gradually, and care was taken not to employ such violence as would cause the rupture of muscles, nerves, or blood-vessels, there appeared to be nothing to contraindicate an attempt at reduction. The consideration of the second question seemed still further to indicate that an at- tempt ought to be made to reduce the dislocation. ‘The present state of the arm was a constant source of annoyance. It was disfigured in shape, was weak, and comparatively useless. As the head of the radius ‘was uninjured and normal in form, it was not considered any objection that the external condyle of the humerus was somewhat altered in form, seeing that it was _ probable that when the bones were put ¢m situ, that part would recover its former size and structure. By effecting the re- duction, therefore, there was every chance of the limb being rendered more useful than it had been since the period of the dislocation. As from the cases related by Flaubert, Marx, and Dupuytren, it appeared that the chief danger in reducing old dislocations arose from the risk of rupturing the muscles, blood-vessels, or nerves, by employing violent efforts at reduction, it was deter-