ends of the bone, and the rawed surfaces fixed in apposition; the
wound is then closed, and appropriate retentive apparatus applied. As
soon as the wound has healed, massage and movement are employed.

CHAPTER IV

INJURIES IN THE REGION OF THE ELBOW AND FOREARM

Surgical Anatomy--Examination of injured elbow--FRACTURE OF LOWER END
OF HUMERUS: _Supra-condylar_; _Inter-condylar_; _Separation of
epiphysis_; _Fracture of either condyle alone_; _Fracture of
either epicondyle alone_--FRACTURE OF UPPER END OF ULNA:
_Olecranon_; _Coronoid_--FRACTURE OF UPPER END OF RADIUS: _Head_;
_Neck_; _Separation of epiphysis_--DISLOCATION OF ELBOW: _Both
bones_; _Ulna alone_; _Radius alone_--FRACTURE OF FOREARM: _Both
bones_; _Radius alone_; _Ulna alone_.

The injuries met with in the region of the elbow-joint include the
various fractures of the lower end of the humerus, and upper ends of
the bones of the forearm, including the olecranon; and dislocations
and sprains of the elbow-joint. The differential diagnosis is often
exceedingly difficult on account of the swelling and tension which
rapidly supervene on most of these injuries, the pain caused by
manipulating the parts, and the difficulty of determining whether
movement is taking place _at_ the joint or _near_ it.

#Surgical Anatomy.#--The medial epicondyle of the humerus is more
readily felt through the skin than the lateral. The two epicondyles
are practically on the same level, and a line joining them behind
passes just above the tip of the olecranon when the arm is fully
extended. On flexing the joint, the tip of the olecranon gradually
passes to the distal side of this line, and when the joint is fully
flexed the tip of the olecranon is found to have passed through half a
circle. The head of the radius can be felt to rotate in the dimple on
the back of the elbow just below the lateral epicondyle. The coronoid
process may be detected on making deep pressure in the hollow in front
of the joint. As the line of the radio-humeral joint is horizontal,
while that of the ulno-humeral joint slopes obliquely downwards, the
arm forms with the fully extended and supinated forearm an obtuse
angle, opening laterally--the "carrying angle." This angle is usually
more marked in women, in harmony with the greater width of the female
pelvis. The ulnar nerve lies in the hollow between the olecranon and
the medial condyle, and the median nerve passes over the