2. Ratchet to fix the Elbow Joint in the Flexed Position.—When at rest the forearm should hang vertically. But the hand can only be used when the elbow is flexed to an obtuse angle or a right angle, the latter position being more often used. Therefore when the patient has bent the joint to the required angle with his sound hand, he must be able to fix it in this position.
This fixation is effected by means of a ratchet attached to the outer side of the elbow, which can be locked or unlocked at will.
This ratchet consists of a flat metal plate with a prolongation upwards shaped like the handle of a fork. The end of this prolongation is attached to the arm steel by a pin joint about 3 centimetres above the axis of the elbow joint. The plate is pierced by a rectangular opening, one border of which is notched; it lies against the forearm steel, a catch projecting from which fits into the opening, this catch, situated 6 centimetres below the axis of the elbow, is of the same diameter as the notches with which it engages. The higher the notch with which engagement takes place the more nearly flexion approaches the right angle.
The width of the opening in the plate is twice the size of the catch, so that the joint works freely when the catch glides on the smooth edge and becomes fixed as soon as the catch engages in the notched border.
It is only necessary to arrange a lock, manipulated through the sleeve, to bring the smooth or the notched border in contact with the catch.
Suppose that the handle of the ratchet is prolonged behind the point at which it is hinged to the arm steel as a little lever furnished with a button, and that an elastic cord or spring is stretched from this button to a point on the postero-external border of the forearm, then if the lever points upwards and the notches are on the upper edge of the ratchet (as is the case in figure [205]), the elastic, pulling the lever forwards, will press the ratchet down and make the notches engage with the catch on the forearm, if, on the other hand, the lever points downwards the elastic traction will release the notches. The reverse occurs if the notches are on the lower edge.
It is then only necessary to arrange a mechanism by means of which this little lever can turn, with a stop which arrests it above at the vertical position, below at a point 45° beyond the horizontal.
Fig. 205.—Elbow ratchet.
A simple mechanism of this sort is shown in figures [206 and 207]. The joint surfaces of the ratchet and of the little lever each bear a shoulder, the former in front, the latter behind, extending over such a proportion of their circumference as will make them act as stops in the desired positions above and below.