Image from page 164 of “American practice of surgery : a complete system of the science and art of surgery” (1906)

Image from page 164 of “American practice of surgery : a complete system of the science and art of surgery” (1906)
Hand Wrist Pain
Identifier: americanpractice03brya
Title: American practice of surgery : a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914 Buck, Albert H. (Albert Henry), 1842-1922
Publisher: New York : W. Wood and company
Contributing Library: University of California Libraries
Digitizing Sponsor: Internet Archive

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Text Appearing Before Image:
half above the carpal end ofthe radius, but we know now that it may occur at any intervening point.(Fig. 52.) Causes.—The most frequent cause is a fall upon the extended hand, as aresult of which the carpus is forcibly pushed upward toward the posterior sur-face of the wrist, thus causing the lower fragment to be displaced upward andbackward. Some believe that the force is received on the ball of the thumb,in the fall on the hand, and that the fracture is due to a cross strain on the bone when the hand is forciblycarried backward. The amountof force varies greatly, depend-ing upon the weight of the bodyand upon the distance andvelocity of the fall. It is re-ported that the fracture mayoccur from other causes. Aslight fall on the floor or theground is sufficient, in the caseof an old person, to cause aColics fracture, the hand, as in other instances, being involuntarily extendedand receiving the force of the fall. Symptoms.—The characteristic deformity to which the name of silver-

Text Appearing After Image:
Fig. 59.—Bonds Splint Padded and Applied. 150 AMERICAN PRACTICE OF SURGERY. fork (Fig. 56) was given by Liston is sometimes so marked as to permit ofa diagnosis at a glance. The hand is deflected to the radial side and pronated,the styloid process of the ulna is prominent, and the lower fragment rides onthe posterior surface of the upper, causing a dorsal elevation. Pronation andsupination may be lost. Crepitus is not needed to establish the diagnosis in thegreat majority of cases. Impaction sometimes occurs, the upper fragment beingdriven into the lower, and the latter at times being split into several piece-.Sometimes the impaction is quite firm, the lower end of the upper fragmentof the radius being felt on the flexor side of the wrist. Broadening at thewrist and lateral projection of the ulna, termed bayonet deformity, aresymptoms usually to be noticed (Fig. 55). Pain may be slight if impaction ispresent. The injuries sustained by the soft parts are extensive. The liga-ments are

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