ever, is a
combination of separated epiphysis with fracture, and this lesion is
produced by the same forms of violence as cause supra-condylar
fracture. If the periosteum is not torn, there is little or no
displacement, but as a rule the clinical features closely resemble
those of transverse fracture above the condyles, or of dislocation of
the elbow. In separation of the epiphysis there is a peculiar
deformity of the posterior aspect of the joint, consisting of two
projections--one the olecranon, and the other the prominent capitellum
with a scale of cartilage which it carries with it from the lateral
condyle (R. W. Smith and E. H. Bennett). The end of the diaphysis may
be palpated through the skin in front. Muffled crepitus can usually be
elicited, and there is pain on pressing the segments against one
another. Sometimes the separation is _compound_, the diaphysis
protruding through the skin.

Union takes place more rapidly than in fracture, but, owing to the
excessive formation of callus from the torn periosteum in front of the
joint, full flexion is often interfered with. If the displaced
epiphysis is imperfectly reduced, serious interference with the
movements of the elbow is liable to ensue, and may call for operative
treatment.

#Fracture of either Condyle alone.#--The lateral condyle or trochlea
is more frequently separated from the rest of the bone than is the
medial or capitellum. In either, the size of the fragment varies, but
the line of fracture is partly extra-capsular and partly
intra-capsular, so that the joint is always involved. Pain, crepitus,
and the other signs of fracture are present. As the ligaments of the
joint are not as a rule torn, there is little or no immediate
displacement of the fragment. Secondary displacement is liable to
occur, however, during the process of union, producing alterations in
the "carrying angle" of the limb--_cubitus varus_ or _cubitus valgus_.

#Fracture of Epicondyles.#--Fracture of the _lateral epicondyle_ alone
is so rare that it need only be mentioned.

The _medial epicondyle_ may be chipped off by a fall on the edge of a
table or kerbstone, or it may be forcibly avulsed by traction through
the ulnar collateral (internal lateral) ligament, as an accompaniment
of dislocation. It is usually displaced downwards and forwards by the
flexor muscles attached to it, and may thus come to exert pressure on
the ulnar nerve. The fragment may be grasped and made to move on