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Fractures of the Forearm.When the arm is held so that the palm of the hand is turned upward and the thumb outward, the radius lies on the outer side, the ulna on the inner side of the forearm. When the hand is turned over so that the palm is downward, the radius makes a revolution about the ulna, the latter remaining in its former position. The rotation of the hand, therefore, about the axis of the forearm is accompanied by a rotation of the radius around the. ulna. In order to accomplish this it is evident that the radius shall not be very firmly fitted into the bone of the arm at the elbow-joint. In fact the radius merely lies in contact with the humerus at the elbow. The ulna, on the other hand - the bone which lies on the side of the forearm corresponding to the little finger - is firmly fitted to the arm-bone at the elbow ; this joint consists chiefly, therefore, of the adjacent surfaces of the humerus and of the ulna. The projection at the back of the elbow, popularly known as the " crazy bone '' is the upper end of the ulna. The movements executed by the bones of the forearm are most delicate and complicated, hence, even a slight interference with them by fracture or dislocation, is apt to be followed by a decrease in the freedom and extent of motion of the forearm. Fractures of the Forearm near the Elbow.-The most frequent fracture affecting this portion of the forearm consists in the breaking off of the upper end of the ulna-the portion called the crazy-bone. This occurs as the result of a fall or blow upon the elbow, and sometimes in consequence of violent muscular contraction of the arm. This fracture is easily detected, since the bone is covered in this position only by the skin. By feeling along the edge of the ulna we find that the point of this bone is separated from the shaft. We can often distinguish a little block of bone which is pulled a short distance from the elbow up the arm. By straightening the arm the ulna approaches somewhat this fragment, which has been broken off and separated from it. In other cases the fragment is not separated much from the rest of the bone, and we can feel distinctly a groove between it and the body of the bone. When the arm is straightened we can detect a grating sensation at the point of injury. A perfectly characteristic feature of this fracture is, that while the movement in the elbow-joint is perfectly free, so that another individual can bend the forearm backward and forward without difficulty, the patient himself is unable to straighten the arm. This results from the fact that the arm is straightened by the contraction of a muscle which is attached to the point of the ulna, that is to the 44 crazy-bone. " In this injury the point of the bone where the muscle is attached is broken off, and hence the patient cannot exert any force upon the forearm so as to straighten the arm. Treatment.-While it is usually an easy matter to replace the broken fragment, it is often impossible to secure a bony union. The fragment becomes united to the rest of the bone by means of a membrane or ligament. If this occur-and it may happen in the hands of the most skillful surgeon-the patient will never be able to straighten the arm completely. When he attempts to do so the fragment to which the muscle is attached is pulled away from the rest of the bone. The first object of treatment is to keep the arm perfectly straight. Probably the best splint for the purpose is that of Dr. Hamilton. This consists of a piece of wood as wide as the broadest part of the arm, and long enough to reach from the wrist to a point three or four inches from the shoulder. At a distance of about three inches below the bend of the elbow, this piece of wood should be notched deeply on either side. This splint, thickly padded with cotton, is placed on the front of the arm so that the notches lie in position about three inches below the elbow. A bandage is then carried around the hand and up the forearm, over the splint. When it reaches the notches, the bandage is passed upward above the elbow, so as to secure a hold behind the broken fragment. When the bandage is carried around to the notch at the other side of the arm and tightly drawn, this fragment is drawn downward so as to come into contact with the bone from which it was broken off. The bandage is carried twice through the notches in this way so as to secure a firm hold on the fragment After this the bandage is continued up to the end of the splint; In order to prevent any soreness or rawness of the skin, it is well to cover the broken fragment with cotton before the bandage is applied. This splint is to be kept in position three or four weeks. At the end of this time the bandage may be removed and the bone examined to see whether the fragment is firmly united to the bone. If it still seems loose, the splint should remain in position for a week or two longer. This fracture is apt to be followed by some stiffness of the joint, which, however, disappears if the arm be gently bent regularly. 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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