Deformity from faulty union following fracture of wrist. Buffalo Clinic. (Skiagrams by Dr. Plummer.)
While Colles’ fracture is far more frequent than all other fractures about the wrist, it is possible to have less-known forms with different displacements; thus a fracture the reverse of Colles’ has been described by Barton and by R. W. Smith, being occasionally produced by falls upon the back of the hand instead of upon the palmar surface. [Figs. 306] and [307], from photographs given me by Dr. Beatson, of Glasgow, illustrate both the clinical picture and the actual condition of the bones. Of all these fractures it may be said that accurate reposition, as in the case of Colles’ fracture, is the key to success. Once the fragments are reduced the same plaster-of-Paris molded splints will answer for these as for the others.
Fig. 306
A Barton or Smith fracture at wrist. (Beatson.)
Fig. 307
Smith’s fracture; reverse of Colles’. (Beatson.) (Skiagram of case represented in [Fig. 306].)
BENNETT’S FRACTURE.
When considerable force is applied to the distal end of the first metacarpal, as in striking with the clenched fist, or, as in a fall upon the outstretched thumb, the first metacarpal is often fractured transversely at its neck or longitudinally, its interior basal projection being broken off, both injuries being often associated. This is a condition lately proved by Russ, of San Francisco, to be more common than has been generally supposed. It was first described by Bennett, of Dublin, in 1885, and is known as Bennett’s fracture of the thumb. Its peculiar features can be best seen in a radiograph. It produces much pain and swelling of the hand, with tenderness, especially at the base of the bone involved, i. e., at the root of the thumb. There may be more or less displacement of fragments. The injured thumb should be treated by traction and with such coaptation splints as may be extemporized or prepared for the purpose, in the position of abduction. If accurate coaptation and sufficient traction be made to overcome both deformity and muscle spasm the result obtained will be satisfactory. Otherwise more or less loss of function and local tenderness may long persist.