ABNORMAL CONDITION OF THE ELBOW-JOINT. 



73 



a. Luxation (if the radius at the elbow-joint 

 forwards. The symptoms of this accident are 

 as follows : the fore-arm is slightly bent, but 

 cannot be brought to a right angle with the arm, 

 nor can it be completely extended ; when it is 

 suddenly bent, the head of the radius strikes 

 a-amst the fore part of the humerus, and pro- 

 duces so sudden a stop to its motion as at once 

 to convince the surgeon that one bone strikes 

 against the other. The hand is placed in a 

 prone position ; but neither its pronation nor 

 its supination can be completely performed, 

 although its pronation may be nearly complete. 

 The head of the radius may be felt on the front 

 and upper part of the elbow-joint, and if rota- 

 tion of the hand be attempted, the bone will 

 be perceived to roll ; this last circumstance 

 and the sudden stop to the bending of the arm 

 are the best diagnostic marks of this injury. 

 In the dissection of this case, the head of the 

 radius is found resting in the hollow above the 

 external condyle of the os humeri. The ulna 

 is in its natural position. The coronary and 

 part of the capsular ligaments as well as the 

 oblique and a portion of the interosseous liga- 

 ments are torn through. The laceration of the 

 latter ligament allows of the separation of the 

 two bones. The biceps muscle is shortened 

 (fig- 43). 



Fig. 43. 



Luxation of the radius forwards. 



We have known an instance in which this 

 accident was produced in the following man- 

 ner : the patient in endeavouring to protect his 

 head from a blow aimed at him by a man who 

 with both hands wielded a spade, received the 

 force and weight of the spade on the edge of 

 the ulna, which, at the same time that it pro- 

 duced a compound fracture of this bone, also 

 dislocated the radius forwards. This latter 

 complication not having been discovered in 

 time, remained ever afterwards unreduced. 



b. Lateral dislocation of the upper extremity 

 of the radius. This is an accident we find 

 alluded to for the first time by Sir A. Cooper, 

 in the appendix to the edition of his work on 

 luxations. He does not adduce any recent 

 case of it, but states that Mr. Freeman brought 



to his house a gentleman, aged twenty-five, 

 whose pony having run away with him when 

 he was twelve years old, he had struck his 

 elbow against a tree, while his arm was bent 

 and advanced before his head, in consequence 

 of which the olecranon was broken, and the 

 radius luxated upwards and outwards above 

 the external condyle. When the arm was bent, 

 the head of the radius passed the os humeri ; 

 he had a useful motion of the limb, but neither 

 the flexion nor the extension was complete. 



As the case here stated is the only one we 

 are acquainted with on record of luxation of 

 the radius upwards and outwards, we may be 

 perhaps excused for exceeding our ordinary 

 limits by relating the following case of this 

 accident ; the subject of it was a very intelligent 

 medical student, about twenty-three years old, 

 and we shall give the case nearly in his own 

 words : 



He writes as follows : " When I was very 

 young, a blow was aimed at my head by a 

 person having a heavy boat-pole in his hands. 

 I endeavoured to save my head by parrying the 

 blow with my left arm. I received the pole on 

 the middle and back part of the fore-arm with 

 a force which knocked me down, and caused a 

 wide lacerated wound where the pole came in 

 contact with it. Whether a luxation of the 

 radius occurred at this time or not was not 

 known, but ever since the accident the arm 

 has been weak, and about seven years ago 

 the weakness increased, and it became liable 

 to partial luxations forwards upon the slightest 

 causes, which luxations I reduced myself by 

 making extension with my right arm, until at 

 length I got a severe fall, which dislocated it 

 to such an extent, forwards and outwards, as to 

 defy my attempts to restore it. The arm was 

 locked in the flexed position, and the head of 

 the radius was to be felt high up, and pro- 

 jecting slightly outside the external condyle of 

 the humerus. The biceps muscle was con- 

 tracted, and its tendon was very prominent, 

 hard, and tense, like a bowstring. The hand 

 was supinated. I suffered little pain, except 

 when extension was attempted, when it became 

 intense. Sir A. Cooper remarks, in his cases 

 of luxation of the radius forwards, that the 

 fore-arm is slightly bent, but cannot be bent 

 to a right angle, nor completely extended. My 

 arm was bent to an acute angle, and could not 

 admit of the slightest extension. The luxation 

 was reduced by extension, and in six weeks 

 passive motion was begun; but I found it 

 painful to use it, and the head of the radius 

 would often catch in the ridge above the ex- 

 ternal condyle, but on extending the arm it 

 returned with a noise into its place. A month, 

 however, did not pass before I was one morn- 

 ing awakened in making some awkward move- 

 ment in my bed, and my arm became luxated 

 worse than ever. On this occasion the surgeon 

 who heretofore had easily replaced the bone 

 found it impracticable to effect it, and called 

 in Mr. Colles to his assistance; but although 

 much force was used it was in vain. From 

 this time the head of the radius never was 



