The ulna and radius are sometimes both fractured together, and sometimes one of them only, either in the middle or at one end, as at the elbow or wrist. The worst of all is when both are fractured together, after that the ulna alone, but a fractured radius is, of all cases, the easiest cured. For, although it be larger than the ulna, yet it has this bone as a base and support to it. If only one be fractured, the extension must be applied principally to it, but if both, they are to be stretched evenly, the arm being put into an angular position, so that the thumb may be higher than the fingers, and the little finger lower than any of the others, for thus the ulna will be placed under the radius. If stronger extension be required, especially when both are broken, we must apply it not only with the hands but also with ligatures, as described when treating of the arm; and everything relative to the bandaging and the subsequent treatment, with the application of the splints, is to be done as in that case until callus is formed. The bones of the fore-arm have their callus formed in about thirty days at most. And the fore-arm is to be otherwise arranged in the same manner as the arm, with the exception of those things which are put under it.
Commentary. Whoever would wish to see a full exposition of the principles upon which these cases of fracture ought to be conducted may consult the first part of Hippocrates’s work. (De Fracturis.) He shows, with a singular precision, the disadvantages of the prone and supine positions of the hand, both of which, it appears, had their advocates in ancient times. The bandages, compresses, and splints are to be applied in the manner described in [the preceding section]. He insists strongly on the necessity of having the arm and wrist carefully suspended in a broad soft sling, and that the hand be placed neither too high nor too low. Hippocrates takes notice of fracture of the olecranon, as will be explained afterwards.
Oribasius gives a description and drawing of a laqueus calculated to retain the splints, and secure the fore-arm in cases of fracture. (De Laqueis, 2.)
Celsus directs us to sling the arm, with the thumb a little inclined, towards the breast, in a convenient napkin (mitella), the broad part being applied to the arm, and the narrow ends tied behind the neck.
Albucasis treats of this case of fracture very accurately. He calls the ulna the larger of the bones. He directs the arm to be suspended with the thumb uppermost. When the fractured pieces of bone occasion irritation, he advises us to make an incision and extract them. When a troublesome pruritus seizes the arm, he recommends us to remove the bandages and bathe with hot water.
Rhases gives proper directions about not applying the bandages too tight or too slack. When the hand swells he recommends them to be slackened.
The accounts given by Avicenna and Haly Abbas are quite similar to our author’s. Avicenna cautions us not to make the splints too long lest they hurt the hand. None of the Arabians, we believe, have noticed the fracture of the olecranon. Like most imitators, they often fall short of their originals.
SECT. CI.—ON THE HAND AND ITS FINGERS.
The bones of the carpus, metacarpus, and of the phalanges of the fingers, being of a spongy and porous nature, are often crushed but rarely fractured. The patient then being placed on a high seat, we are to direct him to lay his hand prone upon an even table, and the fractured pieces being stretched by an assistant, we arrange them with two fingers, that is to say, the thumb and the index-finger. A tight bandage is to be used at the time that inflammation prevails, for, owing to the porous nature of the bones, a redundance of callus is formed. If the phalanx or finger be simply broken, and it be the large one, called also the thumb, after suitable bandaging, it is to be bound to the palm that it may be kept at rest; but if any of the others, as for example, the index or little finger, it is to be bound along with the one next to it, or if one of the middle, it may be bound along with that on either side, or all may be bound altogether. For they are thus kept best at rest, as if the fractured bones had been supported with splints.
Commentary. Hippocrates recommends the general treatment applicable in all cases of fracture, with the exception of the splint, which, as Galen explains, is not admissible in these cases.