25. These gentle motions frequently repeated, when a displacement is no longer to be apprehended, remove that unavoidable rigidity which, for some time, occupies the parts around the joint. It is advisable, for some time, to apply on the hand and extremity of the fore-arm, compresses wet with some discutient liquor, to prevent the swelling resulting perhaps from the inactivity and sprain of the parts. This was the practice of Desault.
I will close this memoir by two cases, extracted from the Journal of Surgery, in order to confirm, by experience, what has been already settled in theory.
Case I. Desault was called to visit a child five years old, supposed to be labouring under a fracture of the arm. He learnt from the parents of the child, that, as it was lying in a very low bed, a young man who was playing with it, had taken hold of its fore-arm, and drawn it towards him, twisting it forcibly at the same time in the direction of pronation; that the effort had been accompanied by a report, and the child had immediately experienced an acute pain throughout the whole limb, but more particularly along the posterior part of the fore-arm.
When Desault saw the patient, no swelling had as yet supervened; the arm was removed from the body, and carried a little forward, while the fore-arm, half-bent, was kept in a state between pronation and supination. There existed, at its lower and back part, a preternatural tumour, formed by the head of the ulna carried behind the sigmoid cavity of the radius. The hand was a little extended, and in a state of adduction. The patient carefully preserved that position, and, as soon as it was changed, or the part affected touched, manifested signs of the most acute pain.
From these appearances, Desault discovered immediately a luxation of the radius forward, which was reduced in the manner already mentioned (16 and 17). By this process, the bones, being a little separated from each other, were replaced with facility. The suffering of the patient was immediately at an end; the limb resumed its natural state, and performed its functions as freely as before; lest some congestion might be the consequence, the injured parts were covered by compresses wet with camphorated spirits; these were secured by a bandage moderately tight, and no accident whatever supervened.
Case II. On the 29th of January, 1789, Madeleine Fuser, a washer-woman, thirty-four years of age, had the lower extremity of the radius luxated forward.
Just as she had finished wringing a sheet, another washer-woman, who was assisting her to wring it, giving it a forcible jerk, did violence to her left arm, which was at the time in a state of strong pronation.
The woman experienced immediately a severe pain, accompanied by a sensation as if something had been torn. The sheet dropt from her hand, and she fell on the ground. Believing that she had received only a sprain, she neglected to apply for aid, and did not enter the Hotel-Dieu till the sixth day after the accident.
There was then a little swelling at the lower part of the fore-arm and at the wrist: the latter was extended and in a state of adduction; the fingers were bent. This woman suffered but little, when her hand was supported and kept still; but the pains became severe, when she attempted to move it. It was plainly perceived that the radius was placed before the ulna, and that the bones overlapped each other.