ompressing the forearm from side to side,
and so making the fractured ends encroach upon the interosseous space.
The dorsal splint is usually made to extend from the olecranon to the
knuckles, and the palmar one from the bend of the elbow to the flexure
in the middle of the palm, a piece being cut out to avoid pressure on
the ball of the thumb (Fig. 42). The splints are applied with the
elbow flexed to a right angle, and, except when the radius is broken
above the level of the insertion of the pronator teres, with the
forearm midway between pronation and supination. The limb is placed in
a sling, so adjusted that it supports equally the hand and elbow in
order to avoid angular deformity. The use of special interosseous pads
is to be avoided.

[Illustration: FIG. 42.--Gooch Splints for Fracture of both Bones of
Forearm. (These are applied with the wooden side towards the skin.)]

When the fracture of the radius is above the insertion of the pronator
teres, the forearm should be placed in the position of complete
supination, with the elbow flexed to an acute angle, and retained in
this position by a moulded posterior splint, and the arm fixed to the
side by a body bandage. Great care is necessary in the adjustment of
the apparatus to prevent pronation.

Massage and movement should be carried out from the first. It is
usually necessary to continue wearing the splints for about three
weeks.

In cases of _mal-union_, especially when the bones are ankylosed to
one another across the interosseous space, operation may be necessary,
but it is neither easy in its performance nor always satisfactory in
its results. The seat of fracture should be exposed by one or more
incisions so placed as to enable the muscles to be separated and to
give access to the callus. When the limb is straight, it is only
necessary to gouge away the exuberant callus that interferes with
rotatory movements; but when there is an angular deformity the bones
must, in addition, be divided and re-set, and, if necessary,
mechanically fixed in good position. In comparatively recent cases it
is sometimes possible, without operation, to re-fracture the bones and
to set them anew.

_Un-united fracture_ of both bones of the forearm is not uncommon and
is treated on the usual lines; the gap between the fragments of the
radius is bridged by a portion of the fibula, that should be long
enough to overlap by at least an inch at either end; it is rarely
necessary t