A CASE OF OLD DISLOCATION 
OF THE ELBOW JOINT IN 
A CHILD—OPERATION—RE- 
COVERY 
CHARLES GREENE CUMSTON, M.D., 
BY 
Boston, Mass. 
T.TTIRA'RY". 
SURGEON GENERAL'S OFFICE 
JUL 2 01909 
From 
PEDIATRICS 
Vol. VII. No. 7. 1899. A CASE OF OLD DISLOCATION OF THE ELBOW 
JOINT IN A CHILD—OPERATION—RECOVERY.* 
Charles Greene Cumston, M.D., 
Boston, Mass. 
Assistant Professor of Surgical Pathology in the Faculty of Medicine of 
Tuft’s College. 
THE case that I have the honor to report is interesting 
firstly as to the pathologic findings, and, secondly, in 
the good result obtained by operative measures in old 
dislocations of the elbow. Bertha K., age u years* 
fell in the first part of February, 1897, striking on her left arm* 
and sustained a backward dislocation of the elbow. 
The patient was first seen on April 12, 1897, just eight 
weeks after the injury had occurred. Careful examination 
showed that the elbow joint was ankylosed and practically en- 
tirely useless. The forearm formed an angle of about 130° 
with the arm. The olecranon could be seen projecting directly 
backwards, while the trochlea humeri could be distinctly made 
out by palpation in the bend of the elbow. 
The patient was put under ether narcosis, and forcible re- 
duction was attempted, but after several unsuccessful trials it 
was abandoned and an operation was decided upon. 
On April 14 ether was again given, and artificial anemia 
of the limb was obtained with Esmarch’s band. Allier’s in- 
cision for resection of the elbow was made, and the ends of the 
bones composing the joint were freely exposed and found in 
good condition. The bones had formed adhesions with the 
capsule of the joint. These adhesions extended from the an- 
terior aspect of the bones of the forearm to the posterior aspect 
of the humerus, at which point they were particularly exten- 
sive and thick. 
On the inner aspect of the humerus and a little above the 
external cpicondyle a pyramidal-shaped process of bone had 
formed, which extended to the head of the radius and was the 
cause of preventing the motion of the forearm. 
* Read by title before the Surgical Society of Itelglurn, March 14, 1899. PEDIATRICS. 
3 
This long prominence, or, more correctly, exostosis, was 
chiseled ofT, the adhesions broken down, and the capsule ex- 
cised, after which the dislocation was easily reduced. The 
forearm was flexed at right angles with the arm, and the joint 
was packed with sterilized subgallate of bismuth gauze and the 
skin incision closed with silk. The limb was placed in a paste- 
board splint. 
The following day the child complained of considerable 
pain in the joint and there was a slight edema of the hand, but 
both symptoms disappeared within twenty-four hours. 
The dressings were removed on the fifth day, and the 
gauze packing was taken out of the joint; the gauze w’as per- 
fectly dry. On the tenth day the skin sutures were removed 
and the incision had united per primam. 
On the twentieth day we began passive movements of the 
joint, which were very painful and ditficult to make, but little 
by little movement became easier, so that within five weeks 
from the lime of operation the forearm could be made to make 
an angle of 320 with the arm. The faradic current was then 
begun and given daily for eight weeks. 
Seven months after the operation, when the patient was 
last seen, the forearm was somewhat pronated, the movements 
of supination were a little limited but pronation was perfect. 
Active extension could be made toan angle of 1250 and flexion 
reached nearly 6o°. 
The child could use her arm, so that she was practically 
in no way inconvenienced, and the result obtained was in every 
way satisfactory. 
871 Hcacon Street VOL 5N9 I JANUARY Ist 1897 %2 A V^Aft 
| PEDIATRICS | 
2T rioKrliiywrni i uustoaiiona Lu