Reprinted from The Medical News, February 25, 1893 
A SPLINT FOR FRACTURES AND LUXATIONS AT 
THE ELBOW-JOINT.1 
By CHARLES W. DULLES, M.D., 
SURGEON TO THE RUSH HOSPITAL AND SUftGEON TO OUT-PATIENTS AT 
THE PRESBYTERIAN HOSPITAL, PHILADELPHIA. 
Inquiries in regard to a splintthat I have devised for 
the treatment of fractures and luxations at the elbow 
having come to me, in consequence of a reference to it 
in a paper on “ Fractures of the Arm,” by Dr. John B. 
Roberts (Annals of Surgery, July, 1892), induce me to 
publish a description of it. 
It is well known, and especially since the instructive 
publications of Dr. Oscar H. Allis on this subject, that 
one of the chief obstacles to the successful treatment of 
fracture at the elbow depends upon the difficulty of pre- 
serving the normal relation between the principal axes of 
the arm and forearm. The normal relation of these 
axes, when the arm is extended, is that of the two lines 
of an obtuse angle; and to preserve this, a certain num- 
ber of surgeons have recently advocated and practised 
the treatment of fractures at the elbow by maintaining the 
forearm in full extension ; for the reason that treatment 
by means of angular splints is often followed by displace- 
ment of one of the condyles of the humerus with loss of 
the normal abduction (outward, or radial, deviation from 
the plane of the axis of the humerus) of the forearm. 
1 Read before the Philadelphia Academy of Surgery, December 
5’ l8g2' 2 
Ever since this danger impressed itself sufficiently 
upon my mind I have been using a splint which has 
proved quite satisfactory in my hands. 
This splint, I make, for each case, from a sheet of light 
tin or sheet brass. On such a sheet I rule lines, guided 
by the sound arm, to mark out the relation of the axis of 
the forearm to that of the upper arm with the whole 
member extended. I then mark the points of the artic- 
ular surfaces of the internal and external condyles and 
draw a straight line across the metal, passing (see figure) 
through them. With a strong pair of shears I then cut 
the whole splint out of the metal, and cut from the an- 
gles at the inner and outer sides toward the middle line 
(in the figure, from A to B and from C to D). I then 
make a few holes with an awl, as shown on the dotted 
semicircle, and bend the sides {A a b B, C c d B, A a' 
b' B, Cc'd' D) backward (as the splint is to be reversed for 
the injured arm) so as to form two troughs, and bend 
these troughs exactly along the line B D, so as to make 
an angular splint. Fixation at the angle required is 
secured by passing through the holes at the sides an 
ordinary brass paper-fastener and bending its ends over. 
The different holes permit of flexion at various angles 
greater than a right angle, and by cutting away from E 
to B and from F to D, different degrees of acute angula- 3 
tion may be obtained. Suitable padding with wool (which 
I prefer to cotton) completes the preparation of the splint, 
into which the arm is placed, with the forearm in supina- 
tion, and in which it is confined by means of a bandage. 
The splint is light and comfortable, and it permits 
examination of the joint at any time, without danger ot 
displacement of the fragments, by simply removing the 
enclosing bandage. In describing it, I do not think it 
necessary to speak of the means for reducing or prevent- 
ing traumatic swelling, which are guided by the princi- 
ples so admirably taught by the late Mr. Sampson 
Gamgee. 
The idea of the splint is to take a piece of light metal 
and convert it into a trough, the shape of which shall 
conform to the lines of the arm in extension ; then to 
flex this trough along a line which corresponds with the 
true plane of the elbow-joint. 
An examination of such a splint will show that it con- 
forms to the proper lines of the arm and forearm in 
extension, and that on flexion the lower trough follows 
very closely the line of movement of the forearm as it 
approaches the humerus. At the same time it will be seen 
that the point at the angle in which the upper end of the 
ulna rests in flexion is lower than that in which the upper 
end of the radius rests, as should be the case, to conform 
the normal anatomic relation of these parts and the nor- 
mal relation of the internal condyle of the humerus to 
the external condyle. The ulna being at the elbow- 
joint a thicker bone than the radius, it is well to have 
the wool cushion on the radial side a trifle thicker than 
on the ulnar side; but in many cases of fracture the 
first swelling compels one to adapt the cushioning rather 
to the condition of the soft parts than to the absolute 
size of the bones and the position of their surfaces. 
A splint of this sort can only approximately imitate 
the conditions of the elbow-joint; but I think it does 
imitate them in a way conducive to good results in the 4 
treatment of fractures. So far as my experience goes, 
the results have justified my expectations. 
Of course, I do not imagine that any one form of splint 
will prove suitable to every case; but this splint is light, 
clean, comfortable, and easy to apply, while permitting 
frequent examinations without risk to the position of the 
fragments, and changes of the degree of flexion as often 
as may be necessary, in each maintaining the normal 
relation of the axes of the arm and forearm. 
A study of the elbow-joint, with a view to securing the 
proper position of the parts after fracture, has led me to 
believe that good results may be obtained by flexing the 
forearm quite fully upon the humerus, in which position 
both ulna and radius act as natural splints to the con- 
dyles. On writing this to Dr. H. L. Smith, of Boston, 
with whom I have had some correspondence on this sub- 
ject, he tells me that he has already experimented on the 
cadaver in this direction, with the result of showing that, 
by this method (the forearm being semi-pronated), the 
condyles were fixed in a correct position. He has also 
treated some cases of accidental fracture in the same way, 
with good results. 
If this experience should be repeated and confirmed 
by others, the splint for elbow-joint fracture would prob- 
ably be a simple V shaped one, placed against the outer 
side of the arm and the back of the forearm. With such 
a splint I am now treating an inter-condyloid fracture of 
the humerus. The patient is entirely comfortable ; the 
bones appear to be in correct position, and I hope for a 
good result. 
4101 Walnut Street.