CASE III. A few days after this, a man, who had left the Hotel-Dieu about eight months before, while under treatment for a similar fracture, returned, to be the subject of a public consultation in consequence of a different disease.
Desault, on interrogating him, learnt from him that the treatment for the fracture had been continued at his own house (31), but that, when the apparatus was removed, no motion had been impressed on the limb, and that the surgeon had even kept it in a sling. The fore-arm was then examined; it was half bent, constantly in a state of pronation, and could not, by any force, be brought into a state of supination. The motions of flexion and extension, were so limited as to be scarcely sufficient for the common wants of the patient, who, under proper treatment, might have been cured like the preceding one, as Desault remarked to his pupils at the time.
34. The patient who was the subject of this second case, was sent to the mineral springs, but derived no benefit from the use of the waters. If this were a proper occasion, I could mention many instances where this remedy, so highly spoken of by many physicians of the present time, has had no effect, except to deprive the patient of more efficacious means, by making him lose that time, during which exercise frequently repeated, would have effected a cure, but which, coming too late, could be of no avail.
35. The ulna, less frequently broken, in general, than the radius, scarcely ever suffers alone from falls on the wrist or hand. Most commonly its fracture is direct, and occurs, in particular, in cases where a person in falling, extends the fore-arm for the purpose of supporting himself, and strikes its internal part against some resisting body.
The division, though it does take place occasionally in all parts of the bone, occurs most frequently near to the lower end, where its slender size, compared to that of its upper end, its more projecting situation, and its thinner covering of soft parts, act as predisposing causes.
36. In whatever part it may exist, the touch must readily detect it, when the fingers are drawn along the internal surface of the ulna, which lies almost immediately under the skin. If moved in contrary directions, the fragments will also, by their mobility and crepitation, disclose the nature of the injury. A depression more or less perceptible is observed on the internal part of the fore-arm, produced by a displacement of the fragments, which are carried towards the radius, more particularly of the inferior fragment, as Petit has well observed, the superior one remaining almost immoveable.
