COLLES'S FRACTURE

COLLES'S FRACTURE. SIR,-The two papers published in the British M1Iedical Journal by Edwards and Clayton (January 12th, p. 61) and by Grasby and Trick (Marclh 2nd, p. 391), are of great interest and importance. Neither, however, seems to me to explain the real cause of disablement in so many of these cases-namely, neglect to reduce the forward luxation of the lower end of the u1na so frequently present. When reduction of the fracture of the radius lias beeni secured, the surgeon's thumb should be placed beneath the displaced lower end of the ulna alnd with a firm thrust it should be pushed dorsally. With this as a fixed point the hand and wrist are swung round into palmar flexion, pronation, and ulnar deviation. Dogma should be avoided in regard to the choice of splints and the position of fixation, but, in severe cases, the extreme Cotton-Loder position indicated above is the best, using moulded gufter splints of metal or plaster.-I am, etc., Edinburgh, March 2nd. W. A. COCHRRANE.