_T- or Y-shaped fractures_ and _fractures of the condyles_, inasmuch as they implicate the articular surfaces, present greater difficulties in treatment, but they are treated on the same lines as the supra-condylar. In young subjects whose occupation entails free movement of the elbow-joint, it is sometimes advisable to expose the fracture by operation and secure the fragments in position. The details of the operation vary in different cases, and depend upon the line of obliquity of the fracture, and the disposition of the individual fragments, points which may usually be determined by the use of the X-rays. In performing the operation, care must be taken to disturb the periosteum as little as possible, otherwise there may follow excessive formation of new bone. Operative interference is sometimes necessary for ankylosis or locking of the joint after the fracture is united, or to relieve the ulnar nerve when it is involved in callus. _Volkmann's ischæmic contracture_ is liable to occur after fractures in the region of the elbow from impairment of the blood supply as a result of tight bandaging. FRACTURE OF THE UPPER END OF THE ULNA #Fracture of the olecranon# is a comparatively common injury in adults. It usually follows a fall on the flexed elbow, and results from the direct impact, supplemented by the traction of the triceps muscle. In a few cases it has been produced by muscular action alone. The line of fracture may pass through the tip of the process, or through its middle, less frequently through the base. It may be transverse, oblique, T- or V-shaped, but is rarely comminuted or compound. _Clinical Features._--As the fracture almost invariably implicates the articular surface, there is considerable swelling from effusion of blood into the joint. The power of extending the forearm is impaired, and other symptoms of fracture are present. The amount of displacement depends upon the level of the fracture, and the extent to which the aponeurotic expansion of the triceps is torn. As the fracture is usually near the tip, the displacement is comparatively slight, the prolongation of the fibres of insertion of the triceps on to the sides and posterior part of the process holding the small fragment in position; and the fracture may easily escape recognition. When the line of fracture is nearer the base, however, the contraction of the triceps tends to separate the fragments widely (Fig. 35), and a distinct gap, which is increased on flexing the elbow, may often be felt between them, and if the elbow is passively extended, the fragments may be brought into apposition, and crepitus elicited. [Illustration: FIG. 35.--Radiogram of Fracture of Olecranon Process, showing marked degree of displacement. (Sir Robert Jones' case. Radiogram by Dr. D. Morgan.)]