. A practical treatise on fractures and dislocations. h year; soon afterward the noduleformed by the union of the trochlea, capi-tellum, and external epicondyle unites withthe diaphysis, and subsequently the noduleof the internal epicondyle unites. Kochersstatement, following Farabeuf, that thetrochlear nodule is the first to unite withthe diaphysis seems to be an error due tomisinterpretation of the peculiar descent ofthe diaphysis into the trochlea, probably through ignorance of the lateappearance of the trochlear nodule. It thus appears that the epiphysisafter about the fifth year is an irr
. A practical treatise on fractures and dislocations. h year; soon afterward the noduleformed by the union of the trochlea, capi-tellum, and external epicondyle unites withthe diaphysis, and subsequently the noduleof the internal epicondyle unites. Kochersstatement, following Farabeuf, that thetrochlear nodule is the first to unite withthe diaphysis seems to be an error due tomisinterpretation of the peculiar descent ofthe diaphysis into the trochlea, probably through ignorance of the lateappearance of the trochlear nodule. It thus appears that the epiphysisafter about the fifth year is an irregular strip of cartilage containingone, or two, bony nodules in its thicker outer portion, and none in itsthin saucer-like trochlear portion, which latter is continuous by a sortof neck with the cartilaginous and bony internal epicondyle. My ownspecimens and skiagrams indicate that the end of the diaphysis afterthe sixth year is much more directly transverse, descends lower on theouter side, than is shown in Fig. 125. Possibly the difference in ap-. Supracondyloid fracture of thehumerus. 244 FRACTURES. pearance depends upon the direction of the line of section, Henle carry-ing it further forward on the outer side so as to include more of theprojecting capitellum. A. Fractures Above the Condyles—Supracondyloid. The line of fracture may be transverse or oblique, and obliqueeither from side to side or from before backward, and it may openthe joint by crossing the olecranon or coronoid fossa or by theextension into it of a fissure between the condyles. It may lie aboveboth epicondyles, or above one and below the other, and, at least at anearly age, may coincide in whole or in part with the epiphyseal line. The cause is violence acting upon the front or back of the lowerend of the bone, usually through the bones of the forearm, as in a fallupon the outstretched hand, or, as indicated by Kochers experiments,by torsion. The commonest cause appears to be a fall upon the handin which
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