ABNORMAL CONDITION OF THE ELBOW-JOINT. 



and ulna are, in their Fig. 44. 



natural state, on an even 

 line with each other. 

 There is scarcely any 

 interosseous interval, the 

 bones seem so closely 

 connected with each other. 

 Indfi.'d, from the inspec- 

 tion of this preparation, 

 we may justly infer that 

 the fore-arm during life 

 had remained much in 

 a state of semiflexion on 

 the arm, and of rigid 

 pronation, and that the 

 movement of supination 

 was nearly impracticable. 

 This defective formation, 

 or atrophy of the capitu- 

 lum and increased deve- 

 lopement of the trochlea 

 of the humerus, which 

 was so formed to ac- 

 commodate itself to the 

 unusual breadth acquired 

 by the coronoid process 

 and the whole of the 

 ulna, must not be con- 

 sidered unprecedented. 

 We find, by referring to 

 the beautiful work of 

 Sandifurt, (the Museum 

 Anatomicum, table ciii. 

 fig. 3,) a case similar to 

 the above delineated 

 (Jig. 45). In referring 

 to it, the author states 

 that the bones of the 

 fore-arm wereanchylosed, 



that the form of the ca- 



..i , . .1 . Citnriemtal (uratwnof the 



pitulum was lost, that J adiui backward ^ 



the head of the radius 

 was luxated completely 

 backwards, and that the 

 ulna alone remained in 

 articulation with the hu- 

 merus ; the parallelism 

 between these two cases 

 will be still more fully 

 seen, when, speaking of 

 the lower articular extre- 

 mity of the humerus, we 

 find that he says, "Figura 

 ergocapituliperiit.Hotula 

 unica, sed major forma- ' 

 tur;" and of the ulna, 

 " insignem acquisivit am- 

 plitudinem et totam infe-,, 



riorem ossis humeri par^T"'"!, 1 



. ' of niiht /mments 

 tern admittere potuit. f roch \m enlarged -no 



In examining very capitulum. 

 lately the splendid col- 

 lection of morbid specimens contained in 

 the Museum of Guy s Hospital, the writer's 

 attention was caught by observing a pre- 

 paration of the radius and ulna, belonging, 

 he is certain, to the same class of diseases 

 now under consideration, namely, congenital 

 luxations of the radius. In this preparation 



Fig. 45. 



there is a very oblique relative position of tlie 

 bones of the fore-arm to each other. While 

 their carpal extremities are exactly upon a line 

 with each other below, the neck of the radius 

 is elongated upwards, and the head of this 

 bone is displaced much backwards, and is 

 situated behind and below the outer condyle 

 of the humerus, and reaches nearly to the 

 summit of the olecranon. The coronoid pro- 

 cess and great sigmoid cavity of the ulna have 

 acquired much breadth, and what is remark- 

 able in this case, and in which it differs from 

 any other we have seen, is, that a process of 

 caries had been going on in the articulation. 

 Cruveilhier has given four drawings of two 

 cases of complete luxation backward of the 

 radius, which he however does not consider to 

 be congenital. Nor is it in our power abso- 

 lutely to prove that they are specimens of 

 congenital luxations backwards, although we 

 feel persuaded that all the cases we have re- 

 ferred to, these inclusive, are very curious 

 specimens of this congenital deformity of the 

 radio-humeral articulation. 



The previous history of all the cases we 

 have collected is totally unknown ; it is re- 

 corded of them all, that the arm was re- 

 markable for its deficient development, that 

 the fore-arm was in a state of demi-pro- 

 nation and demi-flexion, that the movement 

 of extension was incomplete, and of su- 

 pination impossible. Cruveilhier, in the ac- 

 count he has given of both his cases, states 

 that the superior extremity of the radius was 

 at the level of the summit 

 fig. 46. o f t )j e olecranon process 

 (Jig. 46), and that the infe- 

 rior or carpal extremity of 

 the two bones of the fore- 

 arm were on the same pre- 

 cise line below, and that no 

 deformity here existed. The 

 head of the radius and tu- 

 bercle were deformed, or ra- 

 ther imperfectly developed, 

 while there was an elonga- 

 tion of the neck of the ra- 

 dius upwards for more than 

 an inch. Cruveilhier can- 

 not concur with those who 

 consider these cases as ex- 

 amples of congenital luxa- 

 tions, but looks upon them 

 as old luxations, which had 

 been left unreduced. 



For our part we cannot 

 see in these pathological ob- 

 servations any thing to con- 

 vince us that any one of the 

 cases alluded to was an old 

 luxation originally produced 

 by accident or disease. Sup- 

 pose, for argument sake, it 

 be admitted that, from long 

 disease, the form of the 



, capitulum was altogether 

 malformation of the , , i . L j- 



radim, in which ost ' when the radlus was no 

 it was found as longer in contact with it, and 

 long as the ulna, that the acquired breadth of 



