After reduction, the limb is flexed to rather less than a right angle and supported by a sling. Massage and movement are commenced at once.
Fracture of the coronoid process predisposes to recurrence of the dislocation; when this complication exists, therefore, the limb should be fixed at an acute angle, and movements of full extension postponed for a fortnight. Massage and limited movements, however, may be carried out from the first.
If there is a fracture of the olecranon, the treatment must be modified accordingly (p. 87).
[Illustration: FIG. 39.--Forward Dislocation of Elbow, with Fracture of Olecranon.
(Sir Robert Jones' case. Radiogram by Dr. D. Morgan.)]
Comminuted and compound injuries usually call for operative treatment, the fractured bones being wired after reduction of the dislocation, or the loose fragments removed.
The _forward dislocation_ is reduced by fully flexing the elbow, and then pushing the bones of the forearm backward, while the humerus is pulled forward.
_Old-standing Dislocations._--No attempt should be made to reduce by manipulation a dislocation of the elbow which has remained displaced for five or six weeks, especially when it has been complicated by a fracture. The joint surfaces become welded together by adhesions, and separated fragments often form attachments which lock the joint. Attempts to break these down are attended with considerable risk of re-fracturing the bone or of tearing the soft parts. In such cases it is best to expose the joint, and if reduction is not easily effected a sufficient amount of the lower end of the humerus should be removed to provide a movable joint.
#Dislocation of the ulna alone# is a rare injury, and is usually associated with fracture of one or other of its processes or of the inner condyle.
#Dislocation of the radius alone#, on the other hand, is comparatively common, especially as a concomitant of fracture of the upper third of the shaft of the ulna (Fig. 40).
The injury may result from a blow on the back of the upper end of the radius, a fall on the outstretched hand, or, in children, from forcible traction on the forearm while in the pronated position. The displaced head usually passes _forward_, and rests on the anterior edge of the capitellum, thus preventing complete flexion and supination of the limb.