and
avoids movement of the part. Occasionally the median nerve is bruised
or torn, causing motor and sensory disturbances in its area of
distribution.

The general outline of the wrist and hand has been compared not
inaptly to that of "an inverted spoon." Pronation and stipulation are
lost, the joint is swollen, and there is tenderness on pressure,
especially over the line of fracture. Tenderness over the position of
the ulnar styloid may indicate fracture of that process, although it
is sometimes present without fracture. No attempt should be made to
elicit crepitus in a suspected case of Colles' fracture as the
manipulations are painful, and are liable to increase the
displacement.

_Treatment._--It cannot be too strongly insisted upon that success in
the treatment of Colles' fracture with displacement and impaction
depends chiefly upon complete and accurate reduction, and to enable
this to be effected a general anaesthetic is almost essential. The
surgeon grasps the patient's hand, as if shaking hands with him, and,
resting the palmar surface of the wrist on his bent knee, makes
traction through the hand, and counter-extension through the forearm,
with lateral movements, if necessary, to undo impaction. When the
fragments are freed from one another, the wrist is flexed, and the
hand carried to the ulnar side, while the lower fragment is moulded
into position by the thumb of the surgeon's disengaged hand. When
reduction is complete, the deformity disappears, and the two styloid
processes regain their normal positions relative to one another.

As there is no tendency to re-displacement and no risk of non-union,
no retentive apparatus is required, but, if it adds to the patient's
sense of security, a bandage or a poroplastic wristlet may be applied.
In severe cases, however, anterior and posterior splints, similar to
those used for fracture of both bones of the forearm, or a dorsal
splint padded so as to flex the wrist to an angle of 45 deg., but somewhat
narrower, may be employed. The hand and forearm are in any case
supported in a sling.

To avoid the stiffness that is liable to follow, massage and movement
of the wrist and fingers should be carried out from the first, the
range of movement being gradually increased until the function of the
joints is perfectly restored. If splints are used, they should be
discarded in a week, and the patient is then encouraged to use the
wrist freely.

The various special spl