298 



APPLIED ANATOMY. 



other fractures of this region, is to be diagnosed by grasping the fractured part and 

 detecting crepitus and excessive mobility. The medial (internal) condyle is felt 

 firmly attached to the humerus and the olecranon to the ulna, but the lateral (ex- 

 ternal) condyle is felt to move independently of the others. It is efficiently treated 

 by an anterior (not internal) angular splint. 



Intercondylar or T Fracture. When both condyles are detached there is 

 produced what is known as a T fracture. In this injury both condyles are detached 

 from each other and from the shaft of the humerus. The line of fracture may vary. 

 Sometimes there is a transverse fracture above the condyles with a second line 

 passing longitudinally into the joint like the letter T. In other cases the lines may 

 be like the letter V or Y (Fig. 313). 



In all these cases the mobility is very marked and the limb can be bent at the 

 elbow in any direction. The diagnosis is to be made by grasping the shaft of the 

 humerus with one hand and moving each condyle separately with the other. Having 

 determined that each is detached from the humerus, then 

 one condyle is grasped in each hand and they are moved 

 on one another, thus establishing the fact of a fracture 

 between them. 



In treatment the same care must be exercised to detect 

 the occurrence of gunstock deformity as has already been 

 advised in fractures of the medial condyle. In these frac- 

 tures the fragments are frequently rotated on one another, 

 and disability and deformity so often result that in some 

 cases it is advisable to fix the fragments in place by some 

 operative means. 



Fracture of the Olecranon Process. The olecra- 

 non process may be fractured either close to its extremity 

 near the insertion of the triceps tendon, through approxi- 

 mately the middle of the greater sigmoid cavity, or toward 

 the coronoid process. 



The second is the more common. The fracture which 

 occurs nearer the insertion of the triceps is liable to occur 

 from muscular action, the triceps contracting and tearing off 

 the piece of bone into which it is inserted. The shape of 

 the process should be noted. In the bottom of the greater 

 sigmoid cavity near where the process joins the shaft it is 

 constricted and weakened by a groove which sometimes 

 passes nearly or quite across its surface. This is the 

 weakest point and is most often the site of fracture. 



The triceps muscle inserts not only into the upper sur- 

 face of the olecranon but also along its sides. In addition 

 it sends off a fibrous expansion to each side ; the one to the 

 medial condyle is thin, but the one to the lateral condyle 

 forms a broad, tough, fibrous band which stretches from 

 the olecranon to the lateral condyle and passes down over the anconeus to be 

 attached to the outer edge of the upper fourth of the ulna (Fig. 314). In cases of 

 fracture the fragment is only slightly displaced upward by the contraction of the 

 triceps. The reason is that the fibrous expansion of the triceps usually is not suffi- 

 ciently torn to allow of the retraction of the fragment. The amount of separation of 

 the fragments is directly proportional to the amount of tearing of the lateral fibrous 

 expansion of the triceps tendon. By extending the forearm the triceps is relaxed and 

 by pushing the fragment down crepitus can often be elicited. 



Treatment. Fracture of the olecranon process is usually treated with the elbow 

 slightly flexed. Complete extension is not commonly employed. The slight flexion 

 allows for the effusion into the joint and leaves the arm sufficiently extended to relax 

 the triceps. 



An adhesive strip placed across the back of the elbow above the fragment and 

 brought down and crossed on the front of the forearm usually suffices to keep the 

 fragment in position. 



FIG. 313. Intercondylar 

 or T fracture of the lower 

 end of the humerus. Mutter 

 Museum, College of Physicians. 



