THE TREATMENT 
OF 
FRACTURE OF HE LOWER ESI) OF TIE RADIUS. 
BY 
K J. LEVIS, M.D., 
SURGEON TO THE PENNSYLVANIA HOSPITAL AND TO THE JEFFERSON COLLEGE HOSPITAL. 
From the Transactions of the Medicae fwA/rK- 
of the State of Pennsylvania The correct nature and mechanism of the ordinary form of frac- 
ture of the lower end of the radius is now, after much controversy, 
generally admitted and properly comprehended. With this proper 
understanding the indications become rational and decisive. 
In the usual and very characteristic fracture of the carpal end of 
the radius the primary line of fracture is, with little tendency to 
deviation, transverse in direction. Associated lines of fracture are 
generally those of comminution of the lower fragment, and are 
caused by the upper fragment being driven vertically into it and 
splitting it, usually in directions towards its articular surface. 
The displacement of the lower fragment is towards the dorsal 
aspect of the forearm, and its articular surface is inclined in the 
same direction, abnormally presenting backwards and upwards. 
The mechanism of the fracture is its production by falls upon the 
palm of the hand, which, with the carpus, undergoes extreme ex- 
tension, and the fracture is caused by an act of leverage, or transverse 
strain. This direction of force has also been called cross breaking 
strain. 
In this fracture actual displacement of the lower fragment may 
not exist at all, or it may be to the extent of complete separation 
from contact of the broken surfaces, varying with the amount of 
force applied and with the retaining influence of the surrounding- 
dense structures. 
The first essential of the treatment of fracture of the lower end of 
the radius is the complete reduction of the displacement. The action 
of replacement must be directed to the lower fragment itself. The 
reduction of the fracture can usually be thoroughly effected, under 
ansethesia, by strong extension applied to the hand, associated with 
forced flexion of the wrist, and with pressure applied directly on the 
dorsal surface of the lower fragment. Unless vertical splitting or 
comminution of the lower fragment exists, the maintaining of par- 
tial flexion of the wrist, with pressure of a pad on the dorsal surface 
of the fragment, will prevent return of deformity. 
With the object of retaining the apposition of the fractured sur- 
faces, by overcoming displacing forces, I have practised for many 
years on the principles involved in the splint here illustrated, the 
application of which will not require much description. lii the treatment of fracture of the lower end of the radius it is 
essential that proper allowance be made for the curvature of the 
anterior or palmar surface of this part of the hone. This is insured 
in the splint which I have devised, which follows correctly the 
radial curvature; and the fixing of the thenar and hypothenar 
eminences of the hand in their moulded beds, maintains the splint 
immovably in its correct position with reference to the radial curve. 
To neglect of complete primary reduction of the displacement of 
the lower fragment, and to inefficient restoration and retention of 
the normal radial curve, are due the frequent unfortunate sequences 
of this fracture. 
The splint is made of copper, so as to be readily conformable by 
bending to suit the peculiarities of size and form of forearms. The 
series of little pointed elvations along the edge is for the purpose 
of keeping the bandage from slipping. It is tinned to prevent oxi- 
dation. 
The splint will usually fit the forearm so accurately that but 
little padding will be required, and a piece of woven lint, or of cotton 
or woolen flannel is all that is necessary for its lining. No dorsal 
splint is needed, but, as before referred to, a small pad will, in most 
cases, be required over the dorsal surface of the lower fragment. 
For retention of the splint an ordinary bandage, two inches and a 
half to three inches wide, is all that is necessary. 
This splint has the merits of being applicable to all cases of frac- 
ture of the lower end of the radius, and also to many other injuries 
involving the forearm and wrist; it is almost indestructible, and, as 
now supplied, is very inexpensive. It may be obtained by address- 
ing any of the leading surgical instrument makers.