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Fracture of the Forearm Near the Wrist.It is one of the most troublesome of all fractures. No matter what plan of treatment be adopted, there almost invariably remains either some deformity of the wrist, or some impairment of motion, or both. This fracture is, therefore, the subject of innumerable suits against surgeons for malpractice ; it would be well for people to understand that the wrist can rarely be restored perfectly in both form and movement, and that the result will almost inevitably be unsatisfactory. This fracture is easily recognized by the outline of the wrist, to which reference has been already made. The patient will be unable to bend the hand or to turn it toward the thumb side of the arm. Treatment.-It is important to observe whether the fragments are loose and movable, for in many cases the ends of the bone are firmly driven into each other, that is, impacted. If this be the case, and if the patient be old, the fragments should not be separated unless the deformity is very great. For, by permitting them to remain, we are sure of having them held in place more securely than can always be done by a dressing. If the fragments are impacted with great deformity, it becomes necessary to separate them ; this is to be done by pulling firmly upon the wrist. When the fragments are movable, it is very easy to " set" the bone, but not always easy to keep it in place. By simply clasping the hand of the patient and pulling it away from the arm as well as toward the little finger side, the bone falls readily into place ; in fact, it can often be put into position by simply pressing upon the broken ends with the thumbs. In order to keep it in position various methods have been devised. Several objects are to be accomplished by the dressing. The lower fragment is to be drawn down into its position and kept there. The hand must be prevented from falling toward the thumb side, as it naturally does when the bone is thus fractured. The arm must be kept at rest. The usual method for dressing this fracture consists in the application of a splint which, because shaped very much like a pistol, is ordinarily termed the " pistol-splint. " This consists of one piece, the longer limb of which is applied to the forearm, while the shorter limb, which is bent at an angle of about 135 degrees, covers the palm of the hand. This is carefully padded and applied to the front of the forearm and hand, where it is held in position by a firm bandage. By thus turning the fingers toward the opposite side of the arm, we prevent the lower fragment from riding over the upper one and hold it in position. Some surgeons are in the habit of placing a pad, made by rolling up a piece of bandage, between the splint and the edge of the lower fragment; this is rarely necessary. By having the padding of the splint thicker in the middle than at the sides, we keep the fragment of the radius from touching the ulna, and thus prevent the two bones from growing together. Some surgeons use two splints in dressing a Colles* fracture: one similar to that just described, and the other, a straight splint, which is applied to the back of the forearm and covers the wrist. Professor Gunn, of Chicago, often dresses this fracture by simply applying a broad strip of adhesive plaster around the wrist at this point. Whatever dressing be applied, the arm should be supported in a sling which is suspended from the neck. The dressing should be carefully inspected every day, to see that the arm suffers no damage. Somtimes the bandage is applied so tightly as to cut off the circulation in the hand ; this will be indicated by coldness and blueness of the fingers, and must be remedied at once by loosening the bandages. If the patient complain of great pain, the bandage should be loosened and the seat of the fracture examined to see that the parts are in the proper position. After the hand has been thus treated for two weeks, the dressing may be removed and replaced either by a simple strip of adhesive plaster around the wrist, or by a single short splint on the front of the arm, which extends only to the wrist. In this way the hand is permitted to move freely, and the stiffness of the wrist, which often results if the first dressing remain too long, is in great measure avoided. So soon as this second dressing is applied, the hand should be gently bent backward and forward by a second person. In the second week the hand may be slightly rotated, that is, turned over and back. By thus exercising the joints we may succeed in avoiding the stiffness which otherwise results. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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