De Medicina

16 From what was said at the beginning of this book, it can be understood how the three bones, humerus, radius and ulna, meet together at the elbow. If the ulna which is connected to the upper arm slips away from it, the radius which is joined to the ulna is sometimes dragged with it, sometimes remains in position. The ulna can slip out in all four directions: but if it is dislocated forwards, the forearm is extended and cannot be flexed; if backwards, the forearm is flexed and cannot be extended, and it is shorter than on the opposite side; sometimes this causes fever and bilious vomiting. If the ulna has been dislocated outwards or inwards, the forearm is stretched but a little bent towards the part from which the bone has receded. Whatever has happened, there is one method of treatment which holds good not only for the ulna but also for all long bones which are connected at their articulation by a long head. Each limb is to be pulled in opposite directions until there is a gap between the bones. Then the bone which has fallen out of place is forced into the opposite direction from the position into which it has slipped. The methods of extension, however, are various according to the strength of the sinews, and the direction in which the bones have given way. And sometimes only the hands are used, sometimes other means have to be applied. Thus if the ulna has slipped for-

wards, extension by two hands, at times aided by straps, is sufficient; then some round object is to be put in front of the biceps and the ulna suddenly flexed over it towards the upper arm. But in other forms of displacement, it is best to stretch the forearm as described above for fracture of the elbow and then to replace the bones. The rest of the treatment is the same as in all other cases; only the dressing must be taken off more quickly and more often and there must be more plentiful fomentations with hot water, and more prolonged rubbing with oil, nitre and salt. For whether the elbow remains out of place or is put back again, callus forms more quickly round it than round any other joint, and if this callus has grown through resting the joint it prevents flexion afterwards.