In this chapter we are only concerned with the treatment of fractures of the shafts of the radius and ulna in their middle thirds. There are many difficulties in treating the radius and ulna by closed manipulation; closed methods can give excellent results, but the element of luck is rather prominent, and for this reason I am in favour of operative treatment. Some of the difficulties which damp enthusiasm for closed reduction are illustrated in the following sequence of catastrophes:

1. An excellent reduction may be secured by skilful manipulation.

2. The patient may suffer severe pain, with swollen fingers, because a closefitting plaster is obviously necessary; this causes the surgeon considerable anxiety, and may necessitate splitting of the plaster, thus causing further suffering to the patient unless a second anaesthetic is used.

3. When the swelling subsides there is a strong possibility of the initial reduction collapsing.

4. A second manipulation (sometimes the third anaesthetic) may therefore be necessary after fourteen to twenty-one days.

5. This may be followed by further pain and further swelling of the fingers.

6. An excellent reduction obtained initially is rarely ever retrieved by the second manipulation.

7. Delayed union of one or other bone may occur.

8. Limited pronation and supination may result after four to six months of plaster fixation.

9. External deformity may be so great as to be visible even to the patient.

10. […]