FRACTURE OF THE INTERNAL CON DYLE.—This is caused by indirect vio lence through forcing upward the con dyle with the ulna attached to it. The line of fracture runs from the inner side of the humerus downward and outward to the centre of the trochanter or be tween it and the capitellum. Ligament ous attachment to the ulna usually pre vents any marked displacement, and the swelling all about the joints usually ob scures such displacement as there is. The forearm is adducted, however, and abnormal adduction and abduction are possible at the elbow. (These move ments can only be distinguished from ro tation of the humerus when the joint is in full extension: a position but rarely obtainable except under ananthesia.) Independent mobility of the fragment and tenderness on transcondylar press ure should be sought for. Coincident dislocation of the radius backward from the external condyle leaves that part of the humerus prominent anteriorly (see DISLOCATIONS). Unless such disloca
tion is present, the altered relations of the epicondyles and olecranon are likely to be distinguishable through the swell ing.
The treatment is by immobilization in the usual semiflexal position. The posi tions of extreme flexion or extension which have been advocated are incon venient and present no advantages. If the fragment will not remain in place, it must be cut down upon and fixed by suture. Angular deformity is liable to ensue from suspension of the elbow, as in supracondylar fracture, and may occa sionally follow premature ossification of the epiphysial cartilage after fracture of the internal condyle in the adolescent. Excessive formation of callus is likely to impair the functions of the joint, espe cially in the young.