American practice of surgery : a complete system of the science and art of surgery . lity of the elbow joint while it is but slightlymovable actively: by crepitus: and, finally, by swelling of the joint in conse-quence of intra-articular effusion of blood. The fracture is sometimes partlyintracapsular and partly extracapsular. If it results from a direct force only,and the capitellum of the humerus is broken off by the head of the radius, crepi-tus can be determined by pronation and supination of the forearm with thefingers placed on the external condyle. There is often a distinct projection i
American practice of surgery : a complete system of the science and art of surgery . lity of the elbow joint while it is but slightlymovable actively: by crepitus: and, finally, by swelling of the joint in conse-quence of intra-articular effusion of blood. The fracture is sometimes partlyintracapsular and partly extracapsular. If it results from a direct force only,and the capitellum of the humerus is broken off by the head of the radius, crepi-tus can be determined by pronation and supination of the forearm with thefingers placed on the external condyle. There is often a distinct projection infront of the external epicondyle, and behind this is found the head of the radius. FRACTURES. 135 Both condyles are frequently subject to fracture, the internal more oftenthan the external, because it is larger, thinner, and more exposed to the violenceof falls upon the elbow. The direction of the line of fracture separating theinternal condyle from the rest of the bone is a fairly regular one; it begins abovethe base of the epiconclyle and extends obliquely outward and downward. Fig. 42.—Gunstock Deformity in Condyloid Fracture. (Original.) through the olecranon and the coronoid fossa? to the centre of the articular sur-face. (Fig. 40.) The action of the brachialis anticus and triceps muscles pullsthe ulna with the fragment of the condyle upward and backward as far as theattachment of the radius will permit. This upward and backward displacementis increased by any pressure made upon the under surface of the olecranon orby lateral movements of the forearm toward the body. Some rotation of the 136 AMERICAN PRACTICE OF SURGERY. condyloid fragment with anterior displacement is caused when the forearm isextended. The effect of any upward displacement is to lessen the normalhiunero-ulnar angle and to eon veil it into one of the opposite direction, pro-ducing thereby the familiar gunstock deformity (Fig. 42). The line of separation, in a fracture of the external condyle, usually e
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