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Dislocations of the Elbow.The elbow joint is formed by three bones ; above, the lower end of the arm-bone, and below, the two bones of the forearm. The bone which lies on the same side of the forearm as the little finger - called the tilna - is chiefly concerned in the formation of the hinge which constitutes the elbow. The other bone of the forearm, lying on the same side as the thumb and called the radius, enters chiefly into the formation of the wrist joint and forms but a comparatively small part of the elbow joint. At the elbow, the radius merely rests against the lower end of the arm-bone, while the ulna is hollowed out so as to make a deep socket which receives the lower end of the arm-bone. Either one of these bones of the forearm may be dislocated ; or both bones may be displaced at the same time. The ulna alone is sometimes forced out of place by being driven backward ; at other times it is displaced sideways. The most common form is, however, the dislocation of both bones backward. Dislocations at the elbow joint are frequently accompanied with fracture. The socket in the ulna, which receives the lower end of the arm-bone, is so deep that the edge of it is often chipped off when the displacement occurs ; in some cases the end of the humerus fitting into this socket also suffers fracture at the same time. In other cases the arm-bone is broken transversely at a point just above the joint, the lower fragment being pulled backward with the bones of the forearm. The sinews and ligaments which bind together the bones at the elbow are so firm that displacement of the bones can be accomplished only by the exercise of considerable violence. It is usually occasioned by a blow upon the elbow or by a fall in which the weight of the body is transmitted through the elbow. Signs.- The signs of dislocation vary somewhat according to the exact nature of the injury. In most cases the swelling is so great by the time the surgeon arrives, that some doubt as to the exact condition may exist for several days, until the swelling can be reduced by the application of hot cloths. In every case it is important to compare the injured with the sound side ; hence the other arm should be bared for comparison. There are three points-three bony prominences-which serve as landmarks or guides in determining the nature of the injury. These are the two projections from the lower end of the arm-bone, one on either side, and the prominence known as the crazy-bone. When the forearm is bent so that the elbow makes a right angle, the upper end of the ulna constituting the point of the elbow should be situated about half way between the outer and inner projections of the arm-bone. In most dislocations of the elbow, the relation and distance between these three points is markedly different from the natural arrangement. When both bones are displaced backward, the forearm is bent and the palm of the hand turned somewhat downward, the point of the elbow projecting behind the arm. It will be found that the arm can be straightened to a considerable extent without causing extreme pain, but any attempt to bend it beyond a right angle causes acute pain. We can generally feel an unnatural prominence behind the arm, unless the swelling is already very great. Sometimes both bones are displaced outward. In this case the point of the elbow is no longer situated midway between the two bony prominences of the arm ; the inner one of these projects extremely, and the skin is drawn over it very tightly. If the ulna alone be dislocated backward, the palm of the hand is turned downward ; the point of the elbow projects very perceptibly behind the arm. If the radius alone be dislocated, the accident is recognized usually by an impairment in the rotation of the hand. It is sometimes possible to see and feel the extremity of the bone at the front of the elbow-joint. Treatment.- The reduction of dislocation of the elbow is often a difficult task, especially if much swelling has occurred. The arm should be bent over the knee, while the foot of the operator is placed upon the chair in which the patient sits. By bending the forearm around the knee and pulling it at the same time away from the arm, it is sometimes possible to reduce the dislocation. Another way consists in grasping the elbow-joint with the right hand so that the palm shall cover the point of the elbow which projects backward ; the forearm meanwhile is held with the left hand of the operator. By exerting pressure so that the point of the elbow is forced forward and the arm backward with the right hand, the displacement is sometimes relieved. If these efforts be unsuccessful, an assistant should hold the arm and exert pressure downward and outward for a few seconds, while the operator disposes of his hands about the joint in a way so as to exert pressure upon the point of the elbow and upon the lower part of the arm. The forearm should then be bent by the assistant while the operator forces the point of the elbow forward. In many cases it is impossible to reduce a dislocation of the elbow-joint without the use of ether ; under the influence of this drug, the muscles become so relaxed that the manipulations of the displaced bones are much facilitated. Some stiffness of the joint often follows a dislocation ; this can be best avoided by passive motion of the forearm, exerted by a second individual. It will usually be necessary to keep the joint enveloped in hot fomentations for a week or two after the dislocation is reduced. The arm should be carried in a sling. 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