Smith even referred to Pouteau’s original description in his defining of the Colles fracture… He acknowledged the work of Petit and Pouteau work but believed Colles name should be related to the fracture. (**) The carpal surface of the radius does not look directly downwards, its aspect is downwards, forwards, and very slightly inwards.Colles states it to be I have never seen it more than an inch above the carpal end of the bone (*)The situation of the fracture is not so high as Mr.Smith refined the Colles’ anatomical description with corrections footnotes: The fracture is usually the result of a fall upon the palm of the hand, and is liable to happen whenever a person, in the act of falling forwards, throws out before him his arms and hands in a state of extension, which he does, as it were, instinctively, to save the head and face from injury. He recounted Colles’ description in full, adding sketches and further defining the clinical presentation and course Colles, 1814ġ847 – Smith bestowed eponymous immortality upon Colles. During the last three years I have not met with a single instance of Desault’s dislocation of the inferior end of the radius, while I have had opportunities of seeing a vast number of the fractures of the lower end of this bone. I should consider this as by far the most common injury to which the wrist or carpal extremity of the radius and ulna are exposed. His conclusions were firm and direct, and left no doubt that he had described a fracture and not a dislocation. In contrast to Petit and Pouteau, Colles was confident in his observations, even without post mortem evidence. The hard swelling which appears on the back of the hand is caused by the carpal surface of the radius being directed slightly backwards, instead of looking directly downwards.** The carpus and metacarpus, retaining their connexions with this bone, must follow it in its derangements, and cause the convexity above alluded to. The nature of the injury once ascertained, it will be a very easy matter to explain the phenomena attendant on it, and to point out a method of treatment which will prove completely successful. …and further emphasised the clinical features to distinguish distal radius fracture from luxation. Let the surgeon apply the fingers of one hand to the seat of the suspected fracture, and, locking the other hand in that of the patient, make a moderate extension, until he observes the limb restored to its natural form so soon as this is effected, let him move the patient’s hand backward and forward, and he will, at every such attempt, be sensible of a yielding of the fractured ends of the bone, and this to such a degree as must remove all doubt from his mind I hit upon the following simple method of examination, by which I was enabled to ascertain that the symptoms above enumerated actually arose from a fracture seated about an inch and a half above the carpal extremity of the radius. Colles, 1814:183Ĭolles described a means of examination to confirm the distal radius fracture. Indeed, the carpus and base of metarcarpus appear to be thrown backward so much, as on first view to excite a suspicion that the carpus has been dislocated forward. The posterior surface of the limb presents a considerable deformity for a depression is seen in the fore-arm, about an inch and a half above the end of this bone, while a considerable swelling occupies the wrist and metacarpus. This fracture takes place at about an inch and a half * above the carpal extremity of the radius, and exhibits the following appearances. The absence of crepitus and of the other common symptoms of fracture, together with the swelling which instantly arises in this, as in most other injuries of the wrist, render the difficulty of ascertaining the real nature of the case very considerable.Ĭolles contradicted previous belief that these injuries were dislocations of the carpus from the wrist. The injury to which I wish to direct the attention of surgeons has not, as far as I know, been described by any author indeed the form of the carpal extremity of the radius would rather incline us to question its being liable to fracture. Aware his comments would cause intense debate and conjecture, he made certain to assuage his contemporaries with regard to the likely reasons for previous confusion… In both cases, indeed, a convexity behind, and a depression before, or the reverse, are perceived, and are the effect of a displacement of the fragments.”ġ814 – Abraham Colles provided a description of the symptoms of a fracture of the carpal extremity of the radius in the time before X-ray. “There is a circumstance, however, where a fracture near to the joint of the wrist, may give rise to appearances similar to a luxation of that part.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |