This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1899 Excerpt: ...a fall on the elbow, from direct violence, very rarely from mus1'iilar action alone, or from the olecranon being pressed against the humerus in hyper-extension. The symptoms of the fracture are simple, since it is nearly always a transverse one, and since the upper fracture is drawn upwards by the triceps. There is always extravasation of blood in the joint. The patient cannot extend the elbow. As a rule the upper fragment can be drawn down sufficiently to procure crepitus. In those exceptional cases where the periosteum and lateral parts of the triceps are untorn the prognosis is naturally the most favourable, since bony union will almost certainly occur. In the commoner cases where the fragments have been separated fibrous union is the rule. This is partly owing to the fact that there is no periosteum on the joint aspect, but only a thick layer of cartilage, and on either side the fibrous insertion of the triceps; hence callus is formed with difficulty. Treatment.--The arm must be put up with the elbow fully extended, so that the upper fragment which is drawn up by the triceps is approximated as much as is possible to the lower one, and it may be fixed in this position fairly well by narrow bands of strapping, which loop over the top of the ok-cranon. It is obvious that the line of fracture must involve the elbow-joint, and sometimes it is advisable to evacuate by puncture the extravasation into the latter which may he keeping up the separation. An early resort to massage is advisable, and of late has been recommended from the first, and it would appear to have given good results. Primary suture of the fragments may be carried out if the aseptic methods of the operator can be relied upon, and if undertaken with the resources of a surgical clinic is quite ...