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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    mined in this case to extend the arm firmly, but gently, day by day, till the new adhesions of the head of the radius were so much lengthened, or the head so loosened from its new site, that, by the employment of not much additional force, the bone would at last be put into its proper place. The extension was effected by seiz- ing the hand of the patient with the right hand, bending the el- bow-joint so that the fore-arm formed a right angle with the arm, and applying the counter-extension by passing the left hand close above the elbow-joint, and thus fixing the humerus. The exten- sion was then continued till slight uneasiness was complained of. This was repeated daily from the 12th May till the 2nd of June 1847. By this time the head of the radius had become quite loosened, and could be pulled to the edge of the articular head of the humerus. On the 2d of June, therefore, I made the extension and counter-extension myself, and when the head of the radius arrived at the edge of the articular surface of the humerus, allowed the ball of the thumb of the left hand to press against it; when bending the fore-arm on the arm, the bone quietly slipped into its place. The head of the radius was found to have a strong tendency to slip out of its place and return to its former situation in front of the elbow-joint, partly on account of the altered form of the condyle of the humerus, partly from the cavity of the joint being filled with the forementioned elastic fibrous deposit. ‘The arm was therefore kept much bent, and the hand tied up across the chest, so that the tips of the fingers almost touched the oppo- site clavicle. Slight tumefaction, increased heat, and redness, with uneasiness . rather than distinct pain, followed. These were speedily relieved by an evaporating lotion, but no other treatment was required, and the child was allowed to take exercise as usual. Aftera few days, a bandage was applied round the joint, but gave such uneasiness that it was obliged to be removed. No application was therefore made to the joint itself. After the lapse of about a fortnight, slight motion was daily given to the elbow-joint, without, how- ever, lowering the hand or extending the arm. In about three and a-half weeks after the reduction, the fore-arm was lowered so as to form nearly a right angle with the arm, greater motion was daily allowed to the elbow-joint, and frictions were also employed to promote the absorption of the fibrinous deposit, which, from filling the joint, still prevented the close coaptation of the bones. By the 10th of July the motions of the elbow-joint were found on trial to be nearly as extensive as those of the sound arm. The fore-arm could be bent on the arm so as to allow of the hand be- ing put to any part of the head; but when the arm was extended, thehead of the radius threatened to rise and resume its abnormal situation. ‘The arm was therefore so tied that it could not be extended further than a right angle.