
elbow, and a fracture of the lower end of radius. The dislocation was reduced, but owing to swelling of the arm, no splint or bandage was used. During the next few days the arm swelled four or five times the normal size, with such intense pain that the patient was admitted to hospital, and kept under the influence of morphia for eight days. Sensation was lost over the whole hand from the time of injury. Swelling gradually subsided, with a marked inclination to flexor contraction of the wrist and fingers. Attempts were made to rectify the deformity by using a " cock up " splint. Trophic ulcers were present on the knuckles. Recent progress is shown by healing of the ulcers, and some slight return in the finger movement. The whole forearm and hand are much shrunken. This seems to be an example of Volkmann's ischsemic myositis, occurring in the absence of splinting or bandaging. The question arises whether incisions through the deep fascia in the early stages might have prevented the onset.

Discussion.-The PRESIDENT said that in his experience surgery did little good in these cases. He had himself done resection of the radius and ulna, but had not been pleased with the result; the muscle was fibrotic, and possessed practically no contractile power. Volkmann had said, in his (the speaker's) presence, that without a tight bandage or splint, ischoemic paralysis was impossible. Dr. A. P. BERTWHISTLE said he had heard of a case occurring without a splint or tight bandage.

Professor C. A. PANNETT said he wondered whether the condition in this case had comr on as in one of Volkmann's, namnely, with very severe pain, duskiness of the skin and great swelling. Such signs would constitute an indication for incisingf the deep fascia. He had himself recently operated on a boy who had a complicated fracture of the elbow-joint with Volkmann's ischoemic paralysis and an ulnar nerve lesion. He had resected portions of the radius and ulna. Function had then been much improved, and the ulnar paralysis had disappeared. Such an operation might be tried for the present patient if, on te3t, some contractile power was still found in the muscles. In the presence of the median nerve lesion forcible or graiual extension of the flexors-the treatment usually adopted-was contraindicated.

{'paper_id': '44257226', 'title': "Volkmann's Ischæmic Myositis", 's2_url': 'https://api.semanticscholar.org/CorpusID:44257226', 'source': 'S2ORC'}