Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
#Surgical Anatomy.#--The medial epicondyle of the humerus is more
readily felt through the skin than the lateral. The two epicondyles
are practically on the same level, and a line joining them behind
passes just above the tip of the olecranon when the arm is fully
extended. On flexing the joint, the tip of the olecranon gradually
passes to the distal side of this line, and when the joint is fully
flexed the tip of the olecranon is found to have passed through half a
circle. The head of the radius can be felt to rotate in the dimple on
the back of the elbow just below the lateral epicondyle. The coronoid
process may be detected on making deep pressure in the hollow in front
of the joint. As the line of the radio-humeral joint is horizontal,
while that of the ulno-humeral joint slopes obliquely downwards, the
arm forms with the fully extended and supinated forearm an obtuse
angle, opening laterally--the "carrying angle." This angle is usually
more marked in women, in harmony with the greater width of the female
pelvis. The ulnar nerve lies in the hollow between the olecranon and
the medial condyle, and the median nerve passes over the front of the
joint, with the brachial artery and biceps tendon to its lateral side.
The radial nerve divides into its superficial and deep (posterior
interosseous) branches at the level of the lateral condyle.
In _examining an injured elbow_, the thumb and middle finger are
placed respectively on the two epicondyles, while the index locates
the olecranon and traces its movements on flexion and extension of the
joint. The movements of the head of the radius are best detected by
pressing the thumb of one hand into the depression below the lateral
epicondyle, while movements of pronation and supination are carried
out by the other hand. The uninjured limb should always be examined
for purposes of comparison.
In injuries about the elbow much aid in diagnosis is usually obtained
by the use of the X-rays; but in young children it is sometimes
impossible, even with excellent pictures, to make an accurate
diagnosis by means of radiograms alone. In cases of suspected
fracture, a radiogram should be taken with the back of the limb
resting on the plate, the forearm being extended and supinated. If a
dislocation is suspected and a lateral view is desired, the arm should
be placed on its medial side. In obscure cases it is useful to take
radiograms of the healthy limb in the same position.
FRACTURES OF THE LOWER END OF THE HUMERUS
The following fractures occur at the lower end of the humerus: (1)
supra-condylar fracture; (2) inter-condylar fracture; (3) separation
of epiphyses; (4) fracture of either condyle alone; and (5) fracture
of either epicondyle alone.
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