. A practical treatise on fractures and dislocations. , 1878, vol. xxii. p. 34o. 30 FBA CTURES. ^ choiidroid tissue on its diaphyseal side. An important feature isthe fact that the periosteum of the adjoining portion of the shaft isfreely stripped off, preserving its continuity to a large extent with theepiphysis. It has lately been recognized that a partial or completeseparation of the epiphysis of the loAver end of the humerus is frequent(See Plates IX. and X.) ^ The mode of production appears usually to be by cross-strain, thelimb being bent beyond the limit of normal motion in the correspo
. A practical treatise on fractures and dislocations. , 1878, vol. xxii. p. 34o. 30 FBA CTURES. ^ choiidroid tissue on its diaphyseal side. An important feature isthe fact that the periosteum of the adjoining portion of the shaft isfreely stripped off, preserving its continuity to a large extent with theepiphysis. It has lately been recognized that a partial or completeseparation of the epiphysis of the loAver end of the humerus is frequent(See Plates IX. and X.) ^ The mode of production appears usually to be by cross-strain, thelimb being bent beyond the limit of normal motion in the correspond-ing joint or in a direction in which there is normally no motion; forexample, lateral bending at the knee. The displacement may be very slight or so great as wholly to sepa-rate the fractured surfaces from each other. Colless fracture at thelower end of the radius in the young is occasionally a separation ofthe epiphysis with slight displacement (see Plate XIX., Fig. 2); atthe upper end of the humerus the displacement is usually equal to Fig. Separation of the epiphysis. Periosteum partly intact. (Thudicum.) about half the thickness of the bone; at the elbow it may be completebackward or inward, but is usually incomplete inward. The diagnosis is made in the cases of slight displacement on thehistory of the injury and tenderness on pressure limited to the line ofjunction of the epiphysis and shaft; in the others by recognition of thedeformity and of the size and shape of the fragment. When the dis-placement is great reduction may be seriously opposed by the interpo-sition of the loosened periosteum. The prognosis is affected by the possibility of arrest of growth dueto an uncorrected displacement or to premature ossification of the con-jugal cartilage. A few such cases have been reported. This defi-ciency of growth is, of course, most marked in those who receive theirinjury at an early age, and secondly in those cases in which theaffected epiphysis normally takes the lar
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