In certain cases the process of the ulna (olecranon?) behind the humerus
is broken; sometimes its cartilaginous part, which gives origin to
the posterior tendon of the arm, and sometimes its fore part, at the
base of the anterior coronoid process; and when this displacement
takes place, it is apt to be attended with malignant fever. The joint,
however, remains in place, for its whole base protrudes at that point.
But when the displacement takes place where its head overtops the
arm, the joint becomes looser if the bone be fairly broken across.
To speak in general terms, all cases of fractured bones are less dangerous
than those in which the bones are not broken, but the veins and important
nerves (tendons?) situated in these places are contused; for the risk
of death is more immediate in the latter class of cases than in the
former, if continual fever come on. But fractures of this nature seldom
occur.


PART 46
It sometimes happens that the head of the humerus is fractured at
its epiphysis; and this, although it may appear to be a much more
troublesome accident, is in fact a much milder one than the other
injuries at the joint.


PART 47
The treatment especially befitting each particular dislocation has
been described; and it has been laid down as a rule, that immediate
reduction is of the utmost advantage, owing to the rapid manner in
which inflammation of the tendons supervenes. For even when the luxated
parts are immediately reduced, the tendons usually become stiffened,
and for a considerable time prevent extension and flexion from being
performed to the ordinary extent. are to be treated in a similar way,
whether the extremity of the articulating bone be snapped off, whether
the bones be separated, or whether they be dislocated; for they are
all to be treated with plenty of bandages, compresses, and cerate,
like other fractures. The position of the joint in all these cases
should be the same, as when a fractured arm or fore-arm has been bound
up. For this is the most common position in all dislocations, displacements,
and fractures; and it is the most convenient for the subsequent movements,
whether of extension or flexion, as being the intermediate stage between
both. And this is the position in which the patient can most conveniently
carry or suspend his arm in a sling. And besides, if the joint is
to be stiffened by callus, it were better that this should not take
place when the arm is extended, for this position will be a great
impediment and little advantage; if the arm be wholly bent, it will
be more useful; but it will be much more convenient to have the joint
in the intermediate position when it becomes ankylosed. So much with
regard to position.


PART 48
In bandaging, the head of the first bandage should be placed at the
seat of the injury, whether it be a case of fracture, of dislocation,
or of diastasis (separation?), and the first turns should be made
there, and the bandages should be applied most firmly at that place,
and less so on either side. The bandaging should comprehend both the
arm and the fore-arm, and on both should be to a much greater extent
than most physicians apply it, so that the swelling may be expelled
from the seat of the injury to either side. And point of the fore-arm
should be comprehended in the bandaging, whether the injury be in
that place or not, in order that the swelling may not collect there.
In applying bandages, we must avoid as much as possible accumulating
many turns of the bandage at the bend of the arm. For the principal
compression should be at the seat of the injury, and the same rules
are to be observed, and at the same periods, with regard to compression