ABNORMAL CONDITION OF THE ELBOW-JOINT. 



Fig. 40. 



Fracture and retraction of the outer condyle of the humerus. 



although it may be seen in those advanced in 

 life. It is an injury very likely to be mis- 

 taken for a dislocation. 



2. Fractures which engage the upper extre- 

 mity of the bones of the fore-arm are chiefly 

 confined to the ulna, for the radius very seldom 

 suffers. Sometimes the olecranon process at 

 the ulna is broken off, and occasionally a frac- 

 ture of the coronoid process occurs, the con- 

 sequences of which last accident are sometimes 

 very serious. Sir A. Cooper gives us the fol- 

 lowing history : " A gentleman came to London 

 for the opinion of different surgeons upon an 

 injury he had received in his elbow. He had 

 fallen on his hand whilst in the act of running, 

 and on rising he found his elbow incapable of 

 being bent, nor could he entirely extend it ; 

 he applied to his surgeon in the country, who 

 upon examination found that the ulna pro- 

 jected backwards when the arm was ex- 

 tended, but it was without much difficulty drawn 

 forwards and bent, and the deformity Was then 

 removed. It was concluded that the coronoid 

 process was detached from the ulna, and that 

 thus during extension the ulna slipped back 

 behind the inner condyle of the humerus." 



A preparation of an accident, supposed to 

 be similar, is preserved in the Museum of St. 

 Thomas's Hospital ; the coronoid process, which 

 had been broken off within the joint, had united 

 by ligament only, so as to move readily upon 

 the ulna, and thus alter the sigmoid cavity of 

 the ulna so much as to allow in extension that 

 bone to glide backwards upon the condyles of 

 the humerus. 



Fracture of the olecranon. This process of 

 the ulna is not unfrequently broken off, and 

 the accident is attended by symptoms which 

 render the injury so evident that the nature of 

 the case can hardly be mistaken. Pain is felt 

 at the back of the elbow, and a soft swelling 

 is soon produced there, through which the 

 surgeon's finger readily sinks into the joint ; 

 the olecranon can be felt in a detached piece 

 elevated sometimes to half an inch and some- 

 times to two inches above the portion of the 

 ulna from which it has been broken. This 

 elevated portion of bone moves readily from 

 side to side, but it is with great difficulty 

 drawn downwards ; if the arm be bent, the 

 separation between the ulna and olecranon be- 

 comes much Beater. 



The patient has scarcely any power to extend 

 the fore-arm, and the attempt produces very 

 considerable pain, but he bends it with facility, 



and if the limb be left undisturbed it is prone 

 to remain in the semiflexed position. For se- 

 veral days after the injury has been sustained, 

 much swelling of the elbow is produced, there 

 is an appearance of ecchymosis to a consider- 

 able extent, and an effusion of fluid into the 

 joint ensues; but the extent to which these 

 symptoms proceed depends upon the violence 

 which produced the accident. The rotation of 

 the radius upon the ulna is still preserved ; no 

 crepitus is felt unless the separation of the bone 

 is extremely slight. Fractures of the upper 

 extremity of the ulna are sometimes very com- 

 plicated. Thus Mr. Samuel Cooper informs us 

 that there is a preparation in the Museum of the 

 London University, illustrating a case in which 

 the ulna is broken at the elbow, the posterior 

 fragment being displaced backwards by the 

 action of the triceps ; the coronoid process is 

 broken off; the upper head of the radius is 

 also dislocated from the lesser sigmoid cavity 

 of the ulna, and drawn upwards by the action 

 of the biceps. 



Luxations. The bones of the fore-arm are 

 liable to a great variety of lusations at the 

 elbow-joint ; the following arrangement will pro- 

 bably be found to comprehend most of those 

 accidents as yet known and described . 



1. Luxations of both bones backwards; 2. 

 Luxations of both bones laterally, complete 

 and incomplete ; 3. Luxations of both bones 

 laterally and posteriorly ; 4. Luxation of the 

 ulna alone backwards; 5. Luxation of the 

 radius alone forward ; 6. Luxation of the ra- 

 dius externally and superiorly; 7. Complete 

 luxation of the radius backwards ; 8. Sub-lux- 

 ation of the radius backward ; 9- Congenital 

 luxation of the radius. 



1. Luxation of both bones of the fore-arm 

 backwards. This luxation is the most frequent 

 of all those to which the elbow-joint is liable ; 

 it is usually produced by a fall on the palm of 

 the hand,, the fore-arm being at the time ex- 

 tended on the arm, and carried forwards, as 

 when a person falling forwards puts out his 

 hand to save himself. 



The patient suffers at the moment of the acci- 

 dent an acute pain in the elbow-joint, and is often 

 conscious of something having given way in the 

 joint. The fore-arm inclines to a state of supina- 

 tion (fg. 41); the whole extremity is manifestly 

 shortened ; the olecranon process rises very 

 much above the level of the tuberosities; or, to 

 speak more correctly, with reference to the po- 

 sition of the limb, which is always presented to 



