REGION OF THE ELBOW. 



295 



elbow can be bent to its normal acute angle. On extension being made the radius 

 frequently again jumps forward, hence the injury is to be subsequently treated with 

 the arm in a flexed position. 



Brachialis anticus 

 Biceps tendon 



External condyle 



External lateral liga- 

 ment 



Orbicular ligament 



FIG. 310. Anterior luxation of the head of the radius. 



FRACTURES IN THE REGION OF THE ELBOW. 



The elbow is frequently the seat of fractures, especially in children. Their 

 diagnosis and treatment are both difficult and the result sometimes unsatisfactory. 



The bony processes are less distinct in children than in adults and fractures 

 sometimes pass unrecognized, being considered sprains, until the persistent disability 

 or marked deformity betrays their presence. Luxations and fractures are at times 

 mistaken for one another. For these reasons a working knowledge of the anatomy of 

 the region is indispensable. 



The fractures that occur in this region are transverse fractures above the con- 

 dyles and oblique fractures through the condyles, which may either involve the condyles 

 proper (epicondyles so called) and be extra-articular, or involve the articular surface 

 of the trochlea or capitellum. Both condyles may be detached by a T- or Y-shaped 

 fracture: the olecranon may be fractured and also the head or neck of the radius. 



Transverse Fracture of the Humerus above the Condyles (Supra- 

 condylar). This is the most frequent fracture of the lower end of the humerus. 

 The mechanism of its production is not settled. There is little doubt but that it can 

 be produced by hyperextension, as the bone fractures at this point when luxation 

 does not occur. Hamilton regarded a blow on the elbow as the cause. The line of 

 fracture runs transversely across the bone just above the condyles and obliquely 

 from behind downward and forward (Fig. 311, page 296). 



Displacement. The lower fragment is drawn upward and backward and some- 

 times there is an angular lateral deformity with obliteration of the carrying angle 

 (see page 282). 



Signs. The overriding of the fragment produces shortening of the humerus as 

 measured from the acromion to the lateral (external) condyle. The olecranon projects 

 backward, causing a hollow above which resembles that produced in backward lux- 

 ation. The flexure of the elbow is fuller than normal. The relation of the condyles 

 to the tip of the olecranon is not altered. The condyles may, however, lie posterior 

 to a line drawn down the middle of the humerus in its long axis. The sharp edge of 

 the lower fragment can sometimes be felt posteriorly. 



Extension of the forearm causes the fragment to be pushed still farther upward. 



Treatment. There is no single treatment that is applicable to all cases. If the 

 arm is too much extended, the biceps and brachialis anticus are made tense, and 



