Modern surgery, general and operative . agment, causing a dorsalprojection, termed by Liston the silver-fork deformity (Figs. 331, 332).The lower end of the upper fragment can be felt beneath the flexor tendonsabove the wrist. The position in deformity is produced by the force. Someconsider it is maintained by the action of the supinator longus and the flexorand extensor muscles, but particularly by the extensors of the thumb. Pilcherhas demonstrated the fact that in this fracture a portion of the dorsal perios-teum is untorn, and this untorn portion acts as a binding band to hold thefragments
Modern surgery, general and operative . agment, causing a dorsalprojection, termed by Liston the silver-fork deformity (Figs. 331, 332).The lower end of the upper fragment can be felt beneath the flexor tendonsabove the wrist. The position in deformity is produced by the force. Someconsider it is maintained by the action of the supinator longus and the flexorand extensor muscles, but particularly by the extensors of the thumb. Pilcherhas demonstrated the fact that in this fracture a portion of the dorsal perios-teum is untorn, and this untorn portion acts as a binding band to hold thefragments in deformity. Pronation and supination are lost. In this fracturethe hand can be greatly h^-perextended (Alaisonnetives symptom). Crepitus,Avhich is best obtained by alternate h\perextension and flexion, can be securedunless sweUing is great or impaction exists. Crepitus on side movements israrely obtainable. Impaction may greatly modify the deformity, though dis-placement generally exists to some extent, and the fragments do not ride. Fig. 330.—Effect upon the lower endof the radius of the cross-breaking strainproduced by extreme backward flexionof the hand (Pilcher). Figs. 331, 332.—Deformity at the wrist consequent upondisplacement backward of the lower fragment of the radiusafter fracture at its lower extremity (Levis). easily on each other. The styloid process of the ulna may be broken, or theinferior radio-ulnar articulation may be separated (dislocation of the lowerend of the ulna). This latter complication allows the lower fragment to rollfreely upon the upper, and the characteristic silver-fork deformity does notappear. If the styloid process of the ulna is broken, pressure over it causesgreat pain. If a person in falling strikes the back of the hand and a fractureof the radius occurs, the lower fragment is driven upon the front surface ofthe upper fragment and is felt under the flexor tendons at the -wTist (reverseddeformity). An elaborate study of fracture of th
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
