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. 



Indeed, 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 



Sandifort, (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 were anchylosed, 



that the form of the ca- 



pitulum W as lost, tto 



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.Rotula 



unica, sed major forma- 



tur;" and of the ulna, 



" insignem acquisivit am- 



plitudinem et totam infe- 



riorem ossis humeri par- 



tern admittere potuit. 



In examining very 

 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 



irocMta enlarged -no 

 capitulum. 



there is a very oblique relative position of the 

 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 

 of the 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 

 IS K * the ra dis was no 

 it was found as longer in contact with it, and 

 long as the ulna, that the acquired breadth of 



Fig. 46. 



