The various special splints recommended for the treatment of Colles' fracture, such as Carr's, Gordon's, the “pistol splint,” and many others, are all designed to correct the deformity as well as to control the fragments. It has already been pointed out that if reduction is complete there is no deformity to correct, and if it is not complete the deformity cannot be corrected by any form of splint.
Unreduced Colles' Fracture.—When union has been allowed to take place without the displacement having been reduced, an unsightly deformity results. In young subjects whose occupation is likely to be interfered with, and in women for æsthetic reasons, the fracture is reproduced and the displacement of the lower fragment corrected. This is conveniently done by means of Jones' wrench, which grasps the distal fragment and affords sufficient leverage to break the bone.
Chauffeur's Fracture.—A fracture of the lower end of the radius frequently occurs from the recoil of the crank, “by back firing,” in starting the engine of a motor-car. The injury may be produced either by direct violence, the handle as it recoils striking the forearm, or by indirect violence, from forcible hyper-extension of the hand while grasping the handle. The fracture may pass transversely through the lower end of the radius, as in Colles' fracture, but is more often met with two or three inches above the wrist ([Fig. 46]). It is treated on the same lines as Colles' fracture.
Fig. 46.—Radiogram of Chauffeur's Fracture.
Fig. 47.—Radiogram of Smith's Fracture.
(Sir George T. Beatson's case.)
A fracture of the lower end of the radius with forward displacement of the carpal fragment, was first described by R. W. Smith of Dublin (Colles' fracture reversed, or Smith's fracture) ([Fig. 47]). It is nearly always due to forcible flexion, as from a fall on the back of the hand. Like Colles' fracture, it may be transverse or slightly oblique, impacted, or comminuted. The deformity is characterised by an elevation on the dorsum running obliquely upwards from the ulnar to the radial side of the wrist, and caused by the head of the ulna, which remains in position, and the distal end of the proximal fragment. Below this, over the position of the distal radial fragment, is a gradual slope downwards on to the dorsum of the hand. Anteriorly there is a prominence in the flexure of the wrist, and the distal fragment may be felt under the flexor tendons. The hand deviates to the radial side, and thereby still further increases the prominence caused by the lower end of the ulna. The radial styloid is displaced forward, upward, and to the radial side, and the ulnar styloid may be torn off.