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Dislocations at the Elbow-Joint

arm, radius, upper, elbow and dislocation

DISLOCATIONS AT THE ELBOW-JOINT.

'The two bones radius and ulna may be dislocated together, or one of them separately. When both are together the dislocation may be backwards, or forwards, or to one side or other. The ulna may be displaced backwards alone and the radius forwards alone. Some of these varieties are very rare, because, owing to the formation of the elbow-joint, some of them would be extremely difficult to produce with out great injury of other kinds to the joint. The commoner forms are dislocation of both bones backwards and dislocation of the radius alone forwards.

Dislocations of both bones backwards are commonest in childhood and youth. They are often due to a fall on the hand, the elbow being at the time bent. They can be produced by a blow on the lower part of the upper arm from behind driving it forwards, the elbow being fixed.

Signs.—The forearm is bent and fixed. The point of the elbow projects greatly behind, and above the projection is a hollow. In front the lower end of the upper arm-bone stands out prominently, and is pressed down into the bend of the elbow. (See FRACTURE OF LOWER END OF IlumErtus for the distinguishing fea tures between it and this dislocation, p. 85.) The signs of ulna displaced alone are the same, but exist only on one—the inner—side of the joint.

Treatment.-- The simplest method is shown in the figure (Fig. 59). The patient is seated in a chair, the operator's foot rests on the chair, and his knee is placed in the bend of the patient's elbow, resting on the upper end of the forearm, not on the lower end of the upper arm. The person's hand is then grasped, and

the arm pulled round the knee. Another method is to permit one person to hold the upper arm fixed, while a second pulls on the forearm till the bones have been brought down into position. After reduction the arm should be kept in a sling for some days at least, and movement only gradually practised.

Dislocation of the Radius (p. 62) alone is generally forwards. It has frequently occurred in young children from a violent pull, as when they are lifted off the ground by the hand.

Signs.—The elbow is slightly bent, further bending being prevented by the upper arm bone coming against the displaced end of the radius. Straightening of the arm causes pain. The head of the bone—the radius is on the thumb side—can be felt in its unusual position; and that it is the radius can be easily made out by turning the wrist with one hand while the fingers of the other hand are over the dis placed end, which is then felt to turn.

Treatment. — Let an assistant, standing behind the patient, fix the upper arm. Press both thumbs down on the projecting head of the radius, and, at the same time, with the fingers grasping the forearm round about, pull on the forearm, and then bend it. The bone is reduced, but it conies out again very easily. If a pad over the reduced bone and a bandage fail to keep it in its place leave it alone. Through time the head of the bone gets absorbed, and the natural movement is restored.