y operation.

#Fracture of the coronoid process# is rare except as a complication of
backward dislocation of the elbow. It may be produced by direct
violence, as well as by muscular action. As the fracture is usually
within a quarter of an inch of the tip, the fibres of insertion of the
brachialis prevent displacement. The ordinary evidence of fracture is
often absent, and the diagnosis is seldom completed without the aid of
the X-rays. The treatment consists in flexing the elbow and supporting
the forearm in a sling. In some cases associated with dislocation,
however, the small fragment has been so far displaced as to become
attached to the back of the humerus (Annandale).

FRACTURE OF THE UPPER END OF THE RADIUS

Intra-capsular fracture of the #head of the radius# may result from
direct violence, from a fall on the pronated hand, or from forcible
pronation or abduction--that is, deviation of the forearm to the
radial side. It may accompany dislocation of the elbow or fracture of
adjacent bones. The head may be completely separated, or may be split
into two or more fragments. Up to the seventeenth year, the
_epiphysis_, which is entirely intra-articular, may be separated.

The _clinical features_ are localised pain, crepitus, interference
with pronation and supination, while the elbow can be almost fully
extended and flexed, and in some cases the fragment may be felt
through the skin, although it usually continues to move with the shaft
in pronation and supination.

Union generally takes place satisfactorily, but in some cases the
fragments form new attachments resulting in impaired movement at the
elbow, and necessitating operative interference.

Fracture of the #neck of the radius# between the capsule and the
tubercle is rare.

#Avulsion of the tubercle# may occur from forcible contraction of the
biceps, or, in children, from traction made on the forearm (A. L.
Hall).

These injuries are treated with the elbow in the flexed position, and
massage and movement are carried out as already described.

DISLOCATION OF THE ELBOW

Dislocations of the elbow-joint may involve one or both bones of the
forearm, and may be complete or incomplete.

#Dislocation of both bones backward# is the most common of all
dislocations of the elbow, and is the only dislocation that is
frequently met with in children. It usually results from a fall on the
outstretched hand, causing hyper-extension of the joint with
abduction--