Etefi 'lions of the elbow-joint were more numerous in h"! injuries of it much more serious than those which implicate the Lanvv was particularly -'loomy in his p - of wund- of the elliow, and reports manv disasters th'-m. That n -cction nf the elbow is much than amjiutation, n,,t eall pniof as it has been a 'ablished fact. The Thomson teems not to have been san < results to be obtained: I t. fitli.-r or elbow.
Of the latter he sars: "I am satisfied that thclitliculty of the opt-r.. fi.rtli.-.-ui. taining a useful joint. My notes of cases occurring in the Crimea, unfortunately, do not enable me to throw any light on these interesting points. In Schleswic, out of forty excisions, only six patients died, and iwo others were unsuccessful; but in thirty-two instances the. effect was very good. " As regards two of them," says Esmarch, " I have not been able to learn anything with reference to the power of motion they possess; of the rest, eight have very extensive, nine more or less complete, power of motion; it is to be hoped of many of the remainder, that they will be able to obtain much increased mobility by means of zealous exercise of the arm.
On the other hand, thirteen of the cases have a more or less complete anchylosis of the joint." Several of the cases operated on in the East had undergone injury of all the bones entering into the joint, but no case came under my notice in which so much as four or five inches were removed, as was done in the war in the Duchies. Partial resection of which there were a good many cases did not, I think, turn out, on the whole, at all so well as complete ones. They were more tedious, more liable to fail, and less satisfactory when they succeeded, than when the whole articulation was removed. The following were cases of partial removal of the articulation: A soldier of the fusiliers had the head of the radius, and a small portion of the lesser sigmoid notch removed, shortly after injury. two months afterwards, there never having been any attempt made to heal by the parts.
A soldier of the 23d regiment, admitted into the general hospital in GUN-SHOT w,,rxi>s OF JOINTS, ult on the 7tli had the condyle. theemi: pitata. and part of the. -troyed and removed, the suit parts being little injured. Sloughing set in, great constitutional disturbance followed, and had to be performed ilnve months afterwards. If complete excision had Ay performed in both of these cases, I bewe might have obtained much more happy results. <c are only examples of several similar cases. But, a: hand, such cases as the following have occur; 1. A sol di< T. when mounting the heights of Alma, was struck by a rifle ball, which passed across his elbow posteriorly, fracturing the heads of the radius and ulna, but leaving tin- humerus entire.
The broken frag: re removed, and the humerus left untouched; and. after ihnv months' careful treatment, this patient d with a &IUO11B joint, which admitted of a ooiunderable latitude of motion, and with which he in) small weight. In the 9th regime, man was struck by a ball, which condyle of the humerus, without injuring the ulnar iiients were removed by Mr. <M of the iv-iment. The subsequent an arm was retained, ultimately to possess three-fourths of its rial motion. Ksmarch thinks that " tl 'isive jipj.aratus of the joint is u-hai wound of its dan-er. and that tin ved fiom ihadfl of the bones, the. probali!ity of anchvlosis." 'I'll.complet.lixture of the joint durinthe early atment, as so strongly dwrlt upon ly
Stromeyer, its constant support by a splint, even when being dressed; the elevation of it, so as to prevent oedema; its flexure at an angle of 130 to 140, are all points of importance, both as regards the comfort of the patient, and tlu 1 after results. Early passive motion before the wound is wholly cicatrized, but at once abandoned if any irritation or signs of inflammation appear, are also indications which late experience has stamped the value of. The hip was resected six times; five being primary, and one a secondary operation. One of the primary alone succeeded. Such success, although small, is yet encouraging, as compared with the results obtained from were substituted; for, as will be afterwards seen, out of at least 10 amputations at this joint in our army, and some 13 among the French, none survived, and in our cases at any rate the fatal result very rapidly followed the operation.