THE REGION OF THE ELBOW 



59 



Spread of Tuberculous Osteo - Myelitis in the Elbow 

 Region. A focus of tubercle situated in the growing region of 

 the diaphysis of the distal extremity of the humerus is intra- 

 capsular. It may spread (i) towards the medullary cavity ; 



FIG. 22. Elbow of Child, aged five. Lateral View. The condition shown 

 is subsequent to separation of the distal humeral epiphysis, in which the 

 periosteum had been stripped up from the posterior surface of the 

 diaphysis. Owing to malposition of the fragments, a new shaft has been 

 formed on a posterior plane. 



(2) distally, through the epiphyseal cartilage, into the epiphysis, 

 to erupt subsequently through the articular cartilage into the 

 joint ; or (3) if the focus increases in all directions, it will, in 

 spite of the reaction of the periosteum, perforate that membrane 

 where it lines one of the humeral fossae. The disease is then 

 intra-capsular but extra-synovial, and is in direct relation to 



