Notes on the modern treatment of fractures . had the deformity been reduced; and in the history ofthree, if not of all four, it was evident that the true characterof the injury had not been suspected. Well known is the widespread ignorance in the profession of the necessity for very forcible primary reduction of the inferior fragment in the usual fracture of the lower end of the radius with backward displacement. It seems as if there * Transactions American Surgical Association, 1896. 134 THE MODERN TREATMENT OF FRACTURES. exists an even greater degree of ignorance or forgetfulnessof the possi
Notes on the modern treatment of fractures . had the deformity been reduced; and in the history ofthree, if not of all four, it was evident that the true characterof the injury had not been suspected. Well known is the widespread ignorance in the profession of the necessity for very forcible primary reduction of the inferior fragment in the usual fracture of the lower end of the radius with backward displacement. It seems as if there * Transactions American Surgical Association, 1896. 134 THE MODERN TREATMENT OF FRACTURES. exists an even greater degree of ignorance or forgetfulnessof the possibility of the displacement occasionally being for-ward instead of backward. If the possibility of snch displace-ment is generally recollected, it must be that the necessityfor forcible primary reduction is not appreciated, for in thecases seen by me and in the collection of photographs hereexhibited the deformity had not been reduced. This lesion, sometimes termed Smiths fracture of theradius. at otber times called Reversed Colless fracture. Fig. with Probable Stripping up of Periosteum, iMutter Museum.) may be produced, if my experimental and clinical studies arecorrectly interpreted, in three ways: 1. Tearing off of the lower end by a cross-breaking strainexerted through the posterior Ligaments during extreme flex-ion, when the force is applied to the back of the hand in frontof the anterior surface of the radius. 2. Crushing of theanterior petition of the bone between the wrist-bones and theshaft, or mutual penetration of the diaphyseal and epiphysealportions. 3. Rupture of the bony tissue of the weakest pointby decomposition of the force to which the limb is is possible that there may be at times a combination ofmore than one method. In a recent case, treated by my colleague. Dr. 31. , at the Polyclinic Hospital, the character of which wasproved by an immediate skiagraph taken by Dr. Stem, theboy seemed to have received the blow on the palmar
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