the
shaft, producing crepitus. Fibrous union is the usual result.

Up to the age of seventeen or eighteen the epiphysis of the epicondyle
may be separated.

#Treatment of Fractures in Region of Elbow.#--The administration of a
general anaesthetic is a valuable aid to accurate reduction and
fixation of fractures in this region. Much discussion has taken place
as to the best position in which to treat these fractures. In our
experience the best approximation of the fragments, as shown by the
X-rays, is obtained when the limb is fixed in the position of full
flexion with supination. American surgeons favour the position of
flexion at a right angle. In the region of the elbow there is a risk
of promoting too much callus formation by early and vigorous massage,
with the result that the movements of the joint are restricted by
locking of the bony projections. This is probably due to bone cells
being forced into the surrounding tissues, where they multiply and
form new bone on an exaggerated scale.

The _supra-condylar fracture_ is reduced by first extending the elbow
to free the lower fragment from the triceps, and then, while making
traction through the forearm, manipulating the fragments into
position, and finally flexing the elbow to an acute angle and
supinating the forearm. In this way the triceps is put upon the
stretch and forms a natural posterior splint. A layer of wadding is
placed in the bend of the elbow to separate the apposed skin surfaces,
the arm placed in a sling so arranged as to support the elbow, and
fixed to the side by a body bandage. This position is maintained for
three weeks, with daily massage and movement. The last movement to be
attempted is that of complete extension. Operative treatment is rarely
called for.

_Separation of the epiphysis_ and _fracture of the medial epicondyle_
are treated on the same lines as supra-condylar fracture.

_T- or Y-shaped fractures_ and _fractures of the condyles_, inasmuch
as they implicate the articular surfaces, present greater difficulties
in treatment, but they are treated on the same lines as the
supra-condylar. In young subjects whose occupation entails free
movement of the elbow-joint, it is sometimes advisable to expose the
fracture by operation and secure the fragments in position. The
details of the operation vary in different cases, and depend upon the
line of obliquity of the fracture, and the disposition of the
individual fragments, points which