. Röntgen ray diagnosis and therapy . t difficult. The lower fragment pushes towards the dorsum,at which a prominence is seen, near the wrist, corresponding toa groove at the site of the upper end of the fragment. The upper(diaphyseal) fragment presses against the flexors, producing aprominence further upwards. The greater the prominence, theshorter is the radial axis. Crepitus is, even in these typical cases,often absent. In a number of cases, however, the direction of SHOULDEK AND CTPPER EXTREMITY 221 the displacement is found to be towards the ulna, even if thediaphysis is not pronated. The
. Röntgen ray diagnosis and therapy . t difficult. The lower fragment pushes towards the dorsum,at which a prominence is seen, near the wrist, corresponding toa groove at the site of the upper end of the fragment. The upper(diaphyseal) fragment presses against the flexors, producing aprominence further upwards. The greater the prominence, theshorter is the radial axis. Crepitus is, even in these typical cases,often absent. In a number of cases, however, the direction of SHOULDEK AND CTPPER EXTREMITY 221 the displacement is found to be towards the ulna, even if thediaphysis is not pronated. There are also a number of eases observed by the author ;i> well as by others where the lower fragment is turned backwardaround the transverse axis. Sometimes the sagittal axis of thelower fragment is turned around. The oblique type (triangularfragment), in which the joint surface is split, has been spoken ofabove. A rare form is the detachment of the posterior border ofthe joint surface. Roberts also observed forward displacement of. Fig. 1o6.—Fracture of Lower End of Radius, showing Upward and InwardDisplacement and Outward Bending of the fragments. Most of these forms can only be diagnosticated bythe Rontgen rays. By being upwardly dislodged, the lower fragment, in typicalcases, is brought into slight supination, while the diaphysis is indecided pronation. The epiphysis being in very close connectionwith the ulna, the former is slightly pushed towards the ulna ifthe ligamentous connection between the radial fragment and theulna remains intact. This phenomenon finds its conspicuous clin-ical expression in the lateral prominence of the lower end of theulna. Fig. 156, for instance, shows a combination of upward andinward displacement of the lower fragment, followed by outwardbending of the ulna. Wherever displacement demands reposition the assistance of 222 THE RONTGEN RAYS one or two persons is desirable, who should make counter-exten-sion while the surgeon replaces
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