Successful Case of Battey's Operation or Oophorectomy
Authors: H. Smith
Journal: BMJ (1879)

THE BRITISH MEDICAL .OURNAL. in restoring the shape, firmness, and function of the part, and how satis- factory a mode of treatment it is.I nuite admit that in the case of delicate feeble women, who recover badly from any accident, and who have suffered, probably seriously, from the shock of the fall, and who do nothing to help themselves or carry out your instructions, the results are not always so rapid or so satisfactory as I have shown you in the patients with whom we have had to do lately; but these bad cases are the exception, and will, I think, if you strenuously carry out the early and effective setting and passive motion, become very rare in practice.The loss of their patient's confidence, which surgeons frequently sustain in dealing with Colles's fracture, is due chiefly to hesitation in recognising its true nature, the failure to reduce the fragments properly, and the too long fixture and consequent rigidity of fingers and wrist, which result from the commonly followed mode of treatment.I do not find that starch, paraffin, or plaster bandages are desirable in managing this fracture, seeing that they require both time and trouble to remove them.As the poroplastic moulds itself very accurately to the part, no undue pressure is caused, and so no pain.Many surgeons would object to the application of such manipulation as that which I employ when there is any impaction of the fragments, fearing the evil effects of the disjunction of the fragments.I have never found any harm to result, and I cannot recall at present any case in which replacement was impossible.I am aware that such cases have, however, been recorded.I have heard of instances in which, even after the soft parts were removed, the lower fragment could not be got into place; and in one specimen to be seen in the Royal Infirmary Museum, a detached fragment is said to have occasioned this.If I found a tendon so placed and so tense as to appear the cause of the difficulty, I would consider the propriety of dividing it subcutaneously.Without complete replacement of the fragments, deformity cannot be removed, and function quickly and satisfactorily restored.But, to draw these remarks to a close, I may say that the three in- juries with which Colles's fracture may be confounded are sprain and dislocation of the carpus, and transverse fracture low down of the bones of the forearm, with displacement backwards of the carpus and lower fragments.As to the confusion with sprain, it is when neither deformity, crepi- tation, nor unnatural mobility are apparent, and a certain amount of power remains, that fracture is supposed not to have occurred.As, too, in such cases, the head of the radius may rotate when the hand is acted on, it is concluded that the continuity of that bone remains intact.If the pain be concentrated near the lower end of the radius, and below the styloid process of the ulna, and be not diffused over the articulation;and if on making decided extension of the hand, we find unnatural mo- bility-a hollow and a motion-a little way above the lower end of the radius, then it is fracture, and not sprain.It is, however, to be remem- bered that indirect violence does not readily break the bone of a strong adult; and that in such persons the ligament of the joint may be thus