Surgery, Its Principles and Practice; Supplementary Volume. General Militarynaval Technic Fractures Spine & Peripheral Nerves Orthopedic Vascular System - Softcover

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This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1921 Excerpt: ...upon whether the dislocation ended in the first or second stage; if the former, we have a silver-fork deformity, like that of a Colles fracture, but more distally located and sharper. In the second stage there is a distinct prominence over the front of the wrist (Fig. 155). Flexion of the wrist is impossible, and pain due to pressure on the median nerve is present. Fia. 154.--Fracture Of Scaphoid. View of dorsum of wrist showing removal of fragments of scaphoid. (After Hirsch). A lateral roentgenogram is the most satisfactory, especially a stereoscopic one. The semilunar is seen not to articulate with the os magnum, and if rotation of the semilunar has taken place, its articular surface looks toward the palm of the hand or even proximally toward the forearm if it has rotated 180 degrees. The prognosis is bad because of the inability to bend the fingers and also because of nerve disturbances associated with atrophy of the hand and forearm muscles. Fio. 155.--Dislocation Of Semilunar Bone. Lower picture shows lateral view of normal hand. Upper picture shows prominence due to dislocation of all the carpal bones except the semilunar, the prominence due to dislocation of latter being shown in front of wrist. (After Hirsch.) Treatment.--Closed reduction should be attempted in recent cases, especially in those without rotation of the bone. If this is unsuccessful, it is best to remove the displaced semilunar bone through an incision over the front of the wrist (Figs. 15(5, 157). Care should be taken not to open the flexor tendon sheaths. One needs only to divide the attachment of the semilunar to the radius to remove it. Active motion can be begun after the first week. Of 85 cases of removal of the semilunar collected by Hirsch, 38 have given very successful resul...

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