Volume 2

The cyclopaedia of anatomy and physiology / edited by Robert B. Todd.

Date:
1836-1859
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopaedia of anatomy and physiology / edited by Robert B. Todd. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    83/1034 (page 69)
    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. lie 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 slip] ed 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 greater. 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 tho fore-arm are liable to a great variety of luxations 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 (Jig. 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