The healing of the wound has been slow ; no union by first intention taking place, but there was no tendency to the formation of abscesses or sinuses Towards the end of October, a marked shortening of the forearm became apparent. A large amount of callus thrown out from end of humerus, the interference with the muscular attachments at the bend of the elbow causing them to contract, have contributed to form a large amount of swelling on the upper and inner side of the forearm, and the circulation in this part is still defective. has but very trifling use of his band. lie can flex and extend very slightly all his fingers, but he has no power over wrist-joint, none of pronating or supinating the forearm, or of raising it up. The delay ia the wound healing, as well as its extent, necessitated by the length of bone to be removed, has interfered with the use of passive motion of the arm and hand. The amount of use which may be gained hereafter of the arm and hand is at present difficult to say, but it is likely to be limited, owing to the large portions of bone removed, and the separation of muscular attachments. ??
CASE* OF EXCISION OF THE ELBOW-JOINT.
y
Farrell, F.R.C.S.L., 2?!^ Regiment, Tunjab Cavalry. was wounded on the 24th September 1877. He was struck in the left forearm by a rifle bullet which entered apparently on the inner and lower aspect of the limb, about 4 inches below the elbow, and passing upwards and backwards across the limb made its exit a little below the external condyle. The radius and ulna were extensively splintered near the elbow-joint, which was also opened. The soft parts, vessels, and nerves were but little injured. On the above date the bones of the elbow-joint were resected, and for this purpose an incision, some 5 inches long, was made
By Surgeon-Major
G.
the olecranon, and the ends of the bones turned out. The articulating surfaces and portion of both condyles of humerus were sawn off. Nearly 3 inches of the ulna, and more than this of the radius which was split longitudinally, had to be removed, and the wound was then closed in the usual manner. The loss of bony substance at the bend of the elbow must be fully three inches. The bullet had in its course, by splintering the shaft of ulna close to its articulating processes which it divided, destroyed the insertion of the triceps, biceps, and brachialis anticus muscles *, while the injury done to the shafts of both bones implicated the origins and insertions of short supinator, anconeus, and some fibres of superficial flexors and pronators of arm and hand. In the operation the attachments of the muscles at both condyles were necessarily to some extent removed. Little or no haemorrhage took place daring operation, but the local swelling and tumefaction following it was very considerable ; the constitutional disturbance, however, was trifling. On the 15th October, -?was able to sit up for a short time, with arm extended on table beside him, and from this date he gradually improved, his arm being eventually bent to nearly a right angle, bandaged to an angular splint, and suspended in. over
a
sling.
* For the Report of this ease we are indebted to the Surgeon-General, Indian Medical Department, Fort William,?Editob.
CASE* OF EXCISION OF THE ELBOW-JOINT.
y
Farrell, F.R.C.S.L., 2?!^ Regiment, Tunjab Cavalry. was wounded on the 24th September 1877. He was struck in the left forearm by a rifle bullet which entered apparently on the inner and lower aspect of the limb, about 4 inches below the elbow, and passing upwards and backwards across the limb made its exit a little below the external condyle. The radius and ulna were extensively splintered near the elbow-joint, which was also opened. The soft parts, vessels, and nerves were but little injured. On the above date the bones of the elbow-joint were resected, and for this purpose an incision, some 5 inches long, was made
By Surgeon-Major
G.
the olecranon, and the ends of the bones turned out. The articulating surfaces and portion of both condyles of humerus were sawn off. Nearly 3 inches of the ulna, and more than this of the radius which was split longitudinally, had to be removed, and the wound was then closed in the usual manner. The loss of bony substance at the bend of the elbow must be fully three inches. The bullet had in its course, by splintering the shaft of ulna close to its articulating processes which it divided, destroyed the insertion of the triceps, biceps, and brachialis anticus muscles *, while the injury done to the shafts of both bones implicated the origins and insertions of short supinator, anconeus, and some fibres of superficial flexors and pronators of arm and hand. In the operation the attachments of the muscles at both condyles were necessarily to some extent removed. Little or no haemorrhage took place daring operation, but the local swelling and tumefaction following it was very considerable ; the constitutional disturbance, however, was trifling. On the 15th October, -?was able to sit up for a short time, with arm extended on table beside him, and from this date he gradually improved, his arm being eventually bent to nearly a right angle, bandaged to an angular splint, and suspended in. over
a
sling.
* For the Report of this ease we are indebted to the Surgeon-General, Indian Medical Department, Fort William,?Editob.
