eads to stretching of the fibrous band between the fragments and
to marked wasting of the triceps.

Separation of the olecranon _epiphysis_ is one of the rarest forms of
epiphysial detachment (Poland). When the epiphysis is displaced
upwards and unites in this position, it may interfere with complete
extension of the elbow.

_Treatment._--It would appear that too much stress has hitherto been
laid on the necessity of bringing the fragments into perfect
apposition, and too little attention paid to the importance of
maintaining the functions of the triceps and the movements of the
elbow-joint.

Massage and movements are carried out from the first, and the forearm
is supported in a sling. Full flexion is the last movement to be
attempted. In carrying out the movements, the tip of the olecranon is
pressed down with the thumb, so that it is obliged to follow the
movements of the ulna, and is prevented from adhering to the humerus.

It was formerly the practice to have the arm almost, but not quite,
fully extended, and a Gooch splint, extending from the lower border of
the axilla to the finger-tips, and cut to the shape of the extended
limb, applied anteriorly and fixed in position by a bandage, the
region of the elbow being covered by a convergent spica.

_Operative Treatment._--Operative treatment may be had recourse to,
particularly in cases in which there is wide separation of the
fragments. The fracture is exposed, the joint cavity opened up and
cleared of clots, and silver-wire sutures passed through the fragments
without encroaching upon the articular cartilage. The limb is fixed
with the elbow-joint in the position of almost complete extension.
Movement may be commenced at the end of a week, the angle at which the
joint is fixed being changed morning and evening. During the day the
flexed position should be maintained and the arm carried in a sling;
during the night the limb is fixed to a pillow in the extended
position. The patient is allowed to use the joint cautiously within a
fortnight.

_Old-standing Fracture._--When union fails to take place, the interval
between the fragments tends to increase by the contraction of the
triceps gradually stretching the intermediate fibrous tissue, so that
a wide gap comes to separate the fragments. It is quite common that
the function of the arm is all that can be desired in spite of a gap
between the fragments, but, if this is not the case, the fragments may
be united b