Fig. 107.—Contracture of Elbow and Wrist following a burn in childhood. Treated by resection of both joints, and the insertion, on the palmar aspect of each, of a flap from the abdominal wall.
Treatment.—Conservative measures are persevered with so long as there is a prospect of securing a movable joint. The limb is placed in a light form of splint reaching from the axilla to the wrist, flexed to rather less than a right angle and with the hand semi-pronated and dorsiflexed. To inject iodoform or other anti-tuberculous agent, the needle of the syringe is easily introduced between the lateral condyle and the head of the radius. A localised focus of disease in one or other of the bones may be eradicated without opening into the synovial cavity.
If the articular surfaces are so involved that recovery is likely to be attended with ankylosis, the disease should be removed by operation, and cure with a useful and movable joint may then be reasonably anticipated within two or three months. When the patient's occupation is such that a strong stiff joint is preferable to a weaker movable one, bony ankylosis at rather less than a right angle should be aimed at.
Arthritis deformans occurs as a hydrops with hypertrophy of the synovial fringes and loose bodies, or as a dry arthritis with eburnation and lipping of the articular margins.
Neuro-arthropathies are met with chiefly in syringomyelia, and are attended with striking alterations in the shape of the bones and with abnormal mobility.
Pyogenic diseases result from staphylococcal osteomyelitis—chiefly of the humerus or ulna—and from gonorrhœa.
The remaining diseases at the elbow include syphilitic disease in young children, bleeder's joint, hysterical affections, and loose bodies, and do not call for special description.
Ankylosis of the elbow-joint, if interfering with the livelihood of the patient, may be got rid of by resecting the articular ends of the bones, or by inserting between them a flap of fascia and subcutaneous fat derived from the posterior aspect of the upper arm—arthroplasty.
The Wrist-Joint
The close proximity of the flexor sheaths to the carpal articulations permits of infective processes spreading readily from one to the other. The arrangement of the synovial membranes also favours the extension of disease throughout the numerous articulations in the region of the wrist.