Fracture of the internal epicondyle of the humerus

jejund or ileocolic junctions. In this type the tear ma\: extend into the mesentery. Third, the -intestine bursts or explodes because violence causes a rise of hydrauIic pressure within the Iumen and this pressure is sufficient to o\-ercome the resistance of the intestinal naI1. These traumatic Iesions of the intestine caused by non-penetrating blunt force are not pleasant to reflect on. The mortaIity is very high. Nearlv all cases not operated upon die; most of those operated upon

too late die, and of those operated upon earIy many die because of the hemorrhage or peritonrtis which foIIows the injury. The Iesson to be learned is that early exploration should take precedence o\.er watchfu1 waiting \vhen \.ioIent force has been appIied to the abdomina1 waI1. In reviewing the literature, I ha\.e been abIe to find one report onIy which the case cited abo\-e aImost duplicates. In this instance there leas a fataIit\: from peritonitis.

FRACTURE OF THE INTERNAL EPICONDYLE OF THE HUMERUS* ELIAS LINCOLN STERN,

M.D.

NEW YORK

F

ROM a stud)of statistics’ evident that of: a11 the different of fracture of the lower end

it is types of the

indirect \zioIence. In a few cases recorded, the ulnar nerx-e has been injured by the or irritated by pressure origina trauma, of the displaced fragment or portion of callus. The object of the treatment in cases of this type of fracture is to reduce the fracture or remove the fragment, and to restore the elbow joint to its normal condition. The folIowing case is that of a fracture of the internal epicondyle with the most unusual dispIacement of the fragment into the eIbow joint. male, aged t\vclvc J-cars, fell on his forcarm n-hich \vas in the pronntcd Ixxition. Seen irnnictliatcly after the accident, the patient \vas in slight shock, and complained of sex-cm pain in liis right elbow. He also conipl:~incd irnmecliatclv of some numhess on the ulnar- side of ITis hricl. Emniination revealed an irregularity- of the inner contlylc of the humerus, and an almost entirely locked ellmw joint, flexed at aI1out 20 clegrecs. Stcreoscopic radiographs showetl a fracture or the intcrml epiconcl\-lc \vith clispIncenient of the fragrncnt tlownwartl and outw\rarcl into the in close prosiniit>to the olecrano~~ joint, process of the uh. (Figs. 2-4). s. w.,

right

humerus, fracture of the interna epicondyIe is the Ieast frequent. This fracture occurs most often in children, because the interna epicondyIe unites with the body of the humerus at about the eighteenth year, as shown in Figure I. Fracture of the interna epicondyIe frequently accompanies disIocation of the elbow, and may be caused by direct or

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NOVEMBER, ,929

joint normal

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cIcar. The torn internal !igaments and deep fasciae were appro~ini:rtecl \vitli chromic catgut, and the roughcncd are;\ over the innclcondyIe was smoothed. The ~IIMI- nerve xvas Ieft in situ. The skin wound was closed \\.ith silk; no drain RXS used. The patient’s arm was put up on an open mouIded pIaster spIint in cstension for fort!-eight hours. The arm and forearm w’ere then passiveIy mnnipuIated, at iirst very gentI> for only a few minutes, hut increasing a little each da\-. For ten days the forearm was put up in seniifIesion on a posterior mouIdetI spIint when not being mnnipuIatet1. FolIo~~ing this, he received frequent active and passive manipulation, haking, massage, and faradic stimuIation of his muscles, so that at the end of six weeks, the pnticnt had fuI1 range of motion at the ellx~\~ joint. (Figs. 6, 7). The 110~ went to camp for the summer and was advised to partake of the I-arious sports, as tennis and rowing. Upon his return, he had perfect function of the joint, and had no aches or pains. He had developed the muscIes of his arm considerably, and used it as if nothing had e\-er happened to his elbow. Hc had a useful, stabIc eIhow, with full range of motion.

cOscLusIo~

I. EarI~- operation and removal ment of bone from the joint

of fragcavity,

before there is estensix-e injurv to the joint surfaces, is imperative in this type of fracture. 2. Complete nashin~ of the joint cavity free of fibrin a1~c1 blood clots Iessens the tendency towards adhesions. 3. Early and frequent manipulation of the joint, first passive, and then active and passi\ e, is important folIowing the operation. 4. Muscle tonus shouId be preserved ~;_o~“;l~g, massage, and faradic stimua1 . 5, The patient shouId be encouraged to use the elbow- joint at the earliest possible moment. BIBLIOGRAPHY

Frxturcs Fcbigcr, lr)r7. Asriu~s1.. Frxturrs

I. STIVSON.

and Dislocations. ofrhc

T&VES.

Elbow. P.

Fractures dc I’extrcmit6 I’humcrus chcz I’cnfant.

Phila., Lea & 38.

inf&ricurc

GRANGER. Edin. AV. r+ S. J., rq.: 196. SCCDDER. The Treatnxnt of Fractures.

Saunders & Co., 1~23.

de

Phila.,