PRONATION
with
INJURIES
Special
Reference
E.
MERVYN
The
exact
mechanism
sustain
of the
of the
of many
the
of an
forearm
such
injury
fractures
from
apparently
similar
a number
of other
factors
of impact,
the
direction
BIRMINGHAM,
ENGLAND
in which
Accident
is often
difficult
to
unknown.
on the
involved,
the
body
determine.
precise
details
Why,
ends of the radius
and yet another
falls
are
Fracture
Hospital
to give
still
lower
radius,
FOREARM
Monteggia
able
is thus
of the
of the
THE
Anterior
Birmingham
is seldom
a greenstick
fracture
epiphysis
of the head
humerus,
all
must
be that
time
mechanism
fracture
the
EVANS,
From
severe
to
OF
A patient
of his
with
accident,
for instance,
and
should
one
a
the
child
and ulna,
another
a separation
a supracondylar
fracture
of the
outstretched
such as the
is falling,
and
hand ?
position
The answer
of the elbow
surely
at the
so on.
‘1
3
4
FIG.
With
forearm
a
fall
forward
is pronated
1
on
and
to
the
the
hand
hand
is
the
palm
FULCRUM
downwards.
at the
nation
If the
body
is twisting
moment
of
impact,
force
is
humerus
transmitted
to the
outwards
a
strong
pro-
through
the
forearm.
FIGS.
Diagrams
right
the
by
illustrating
forearm
are
junction
of
the rotation
of the
ulna
pronation
When
acts
force
a patient
seen
until
give.
causes
the normal
The ulna
above
by
combination
378
mechanism
from
the
of pronation
lateral
their
upper
and
middle
force
shown
here
or by
aspect.
falls
external
range
cannot
forward
of impact
of the
rotation
injuries
In
thirds
angulatory
as a fulcrum
over
which
continues
(Fig.
3).
The
(Fig.
4) or a transverse
and at the moment
downward
momentum
trunk
the
pronation,
(Fig.
2).
on to the
The
strain.
the
upper
end
result
is either
fracture
near
At
the
outstretched
humerus
and
hand
ulna
may
same
the
be
The bones
of the
ulna cross
near
fractured
time
the
either
upper
third
forearm
if the
radills
is already
pronated
fixed
to the ground.
is added
when
twisting
(Fig.
of pronation
at the radio-ulnar
joints
rotate,
because
it is fixed below
by
its articulation
with the humerus.
of the rotation
force and of the
ulna
the
and
of the radius
is forced
forwards
dislocation
of the head
of tile
its upper
end
(Fig.
5).
the hand
becomes
relatively
falling
body
a rotation
force
of
2-5
of the forearm.
the radius
1).
If
this
force
To the
of the
continues
is expended,
something
the ulnar
carpal
ligament
must
and
The ulna is therefore
liable to fracture,
and the
bending
force set up by longitudinal
compression
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
1’RONATION
1)r(.illc(
I1hL
set
out
t11
by
I iaiisvci’
)bli(1UU,
(
Messerer
INJURIES
(Figs.
l)tltt(rflY
1
(
2 to
5).
OF’
same
time
in
accordance
the
radius
pronation
and lies across
the ulna, at the junction
of the
ulna fractures,
the two bones
come into contact,
and the
over which
the upper
end of the radius
is forced
forward.
the
radius
is either
levered
third.
On theoretical
injuries,
all of which
forward
out
grounds,
then,
are well-known:
one
of the
579
FOREARM
fracture
the
At
THE
superior
with
the
is forced
upper
and middle
point
of contact
As the pronation
radio-ulnar
joint
principles
into
extreme
thirds.
As the
forms
a fulcrum
force continues,
or is fractured
in its
upper
angulation
and
occasionally
anterior
the
dislocation
head
of
the
ulna
as
of
the
hea(l
of the
or
above
radius
Although
mainly
with
which
has
(1943)
stated
adults
in
the
that
of the
Closed
ulna
in
and
sometimes
In
such
plating
by
with
the
they
fracture
good
flexed
might
by
who
ulna
treated
reduced
was
closed
by
methods
advocated
open
emphasized
up
to the
Mechanism-Most
of
for
and
and
that
In
no
forces
one
case
of his
to
site
be
Boyd
radiochildren
biceps
and
the
present
tile
skin
injury
of the
the
4,
NOVEMBER
ulna
severe
series
was
with
Cononly
the
by
elbow
and supination.
has not been
injury
is due
the
radius
forward.
there
ulna
are
to a direct
point
\Vhule
it
several
old
case
fracture
anterior
is
reasons
the
head
the
of
nonand
of
radius
hcacifin
‘
“
of Monteggia
illustrating
of tile
ulna
dislocation
union
.
at the
is subcutaneous
bruising
this
well
so;
away
and,
or breaking
one
case
from
the
was
to direct
violence,
Naylor
ulnar
fracture
which
in a large
in
1949
the
only
case
if the
fracture
of tile
skin
indeed
supposed
is due
Nevertheless
NO.
pronation
in flexion
supination
occur,
to find
anteriorly
the
31 B,
reported
fractures
the
of
sometimes
site
VOL.
been
noted
e
0
exceptional
that
compound.
which
Ilead
at the
be
and
An
of fracture
expect
in
belief
the
would
penetrated
bruising
the
supination.
the
consider
forearm
may
it
1) At the
the
of
this
helievillg
had
been
and
present.
.
back
impact
violence,
have
by manipulation.
and
have
traction
authorities
the
possil)le
a
and
in
reduction
traction
by
90 degrees
and, if this failed,
traction
the primary
importance
of
on
of
gave
superior
that
relax
to
Nevertheless
blow
of the
stated
‘ ‘
and
spica.
Speed
be reduced
mentioned,
of
cent.
in a plaster
repair
injuries
reduction
supination
they
supination
the
and
open
authors.
but
fracture
dislocation
Watson-Jones
surgeons
advised
with
injury
of the
results
(1942)
Naylor
the
advise
dislocation
sistently
ulna
; 3) anterior
treatment
6).
fixation
sling,
fracture;
; 2)
concerned
in 95 per
many
several
of
is
the
in
time
muscles
and so diminish
the upward
pull of the biceps
on
head
and the radial
pull on the ulna by the supinator.”
reported
a case
of lateral
dislocation
of the
head
of the
(1941)
radius
of the
a fascial
in adults
cases
supinator
the radial
by
any
paper
immobilisation
Monteggia
same
FRACTURE
disability
He
literature
of the
the
ulna.
(Fig.
post-operative
and
the
(1940) advocated
ulnar
dislocation
that
with
radius
cause
by
complications.
reduction
mentioned
\Vise
permanent
treated
of
shaft
fracture,
of
cases
of the
difficult
to cause
one of three
third
with backward
anterior
at
this
Monteggia
it caused
a series
list
plating
may
1947),
considered
radius-the
is damaged
MONTEGGIA
pronation
been
of the
pronation
in its middle
radius
of the
ANTERIOR
anterior
long
formidable
fracture
(Fitzgerald
expect
forced
of the ulna
head
the
fracture
without
forced
others
of
a high
THE
probably
of the
epiphysis
with
would
1) fracture
of compound
that
proportion
fracture
to
was
direct
of impact.
but
of impact.
there
due
point
compound,
point
stated
were
at the
the
In
ulna
support
considerable
of cases
was
reported
in
said
to
detail
in
E.
580
his
review
the
of a patient
wound
taken
If the
:;)
coinminution
3)
the
on the
on admission
;
the
of
is usually
was that
compression
When
sustained
of both
also
fracture
than
the fracture
longitudinal
injury
was
the
seen.
aspect
skin
over
‘were
diit’
in
the
at roughly
the
one would
; in no case
same
level,
of the
the
forearm.
nIna
Figure
7 is a photograph
is unmarked.
direct
to
Monteggia
)n’
ilcuct’
V1(
fractures
ul(I
V(
reported
here
expect
from
either
a rotation
was the fracture
comminuted.
patients
have given
a clear
has been either
a fracture
bones
EVANS
anterior
ulna
which
force
M.
history
of the
but
of
a blow
shaft
on
of the
in no case
the
of the
of
from
or
forearm,
or fractures
a forward
iliore
pattern
strain
back
ulna
expect
the
the
of the
dislocation
a
shafts
of the
head
of
radius.
4)
joint
It
Finally,
is strong
seems
some
unlikely
of the
action
dissected
anteriorly
force
as the
specimens
and
that
a direct
were
spent
radius
crosses
soon
with
a Monteggia
after
prominence
Tile
skin
clearly
blow
the
the
would
ulna
that
by
be
in fracturing
the
the
capsule
supinator
sufficient
ulna
of the
brevis
to
cause
; a twisting
in pronation,
would
to
by the
ulnar
superior
and
photographed
be much
hospital.
Note
displaced
fracture
radiograph
of
fracture
tilting
of
lile
type
\var(l
the
radial
head.
is unmarked.
tile
radio-ulnar
brachialis
muscles.
dislocation,
force,
more
of
in
by
likely
if
leverage
to do so.
8
an
anterior
Monteggia
a child,
showing
backilead
of the
radius
with
tile
forearm
especially
increased
FIG.
fracture
admission
caused
over
the
show
protected
7
FIG.
A child
is
ill
Ileutral
rotation.
Confirmatory
evidence
of the mechanism
of the Monteggia
fracture
is shown
in the case
illustrated
in Figure
8. The lateral
view of the forearm
in neutral
rotation
shows
tilting
of
the
epiphysis
that
such
of the
head
epiphysial
of the
capitellum
while a valgus
strain
tilts laterally.
Here in neutral
radius
has
at the
moment
been
radius
displacements
externally
in
addition
are
to
caused
anterior
by
the
of
is being thrown
on the joiflt,
rotation
the epiphysis
is tilted
rotated
through
90
degrees
It is well
dislocation.
head
the
radius
and that
backward,
from
the
the
epiphysis
indicating
position
of
known
striking
full
the
always
that the
pronation
of injury.
TABLE
RESULTS
OF
PRONATION
STRAIN
Fracture
12
cases
dislocatioll
ON
I
THE
FOREARM
of the ulna
in
of the
head
-
cases
1 case
Fracture
of the
fracture
of
ulna
Anterior
dislocation
the
Dislocation
.
of
fracture
SPECIMENS
and
anterior
(the
anterior
fracture)
in its
radius
EIGHTEEN
its middle
third
of tile
radius
Monteggia
3 cases
IN
tile
middle
third
just
below
head
of the
of
THE
tile
of
ulna
the
and
transverse
tile
tuherosity
radius
witilout
elbow
JOURNAL
OF
BONE
AND
JOINT
SURGERY
PRONATION
Experimental
In Figure
caused
a
9 the
production
limit
spiral
of
of tile
normal
fracture
of
Figure
Experimental
work-In
fracture,
experiments
as follows:
the soft
and
vice
ligaments
and the
A typical
VOL.
31 B,
11
an
were
tissues
NO.
4,
ulna
shows
type
has
and
the
to
OF
THE
of fracture-dislocation
been
reached.
incomplete
rupture
forward
dislocation
determine
the
1949
membrane;
the
shaft
in a wooden
clamp
just
in
Figures
9 to
11 and
581
FOREARM
by
Further
of the
completed.
mechanism
carried
out on eighteen
dissecting-room
were removed
from the elbow
and
is shown
NOVEMBER
Monteggia
pronation
the
attempt
and the interosseous
forearm
was gripped
experiment
INJURIES
the
of the
force.
(Fig.
10)
ligament.
anterior
Monteggia
specimens.
The procedure
was
forearm,
leaving
only the capsule
of the
above
pronation
rotation
orbicular
humerus
the
results
was
wrist
and
are
held
slowly
shown
firmly
in
a
pronated.
in Table
I.
E.
582
In
find
the
that
twelve
the
was
screwed
and
then
forward
“
out
injuries
ulna
was
screwed
out
was
fractured
111 tiliS
experiment
Figure
12 silOws
The
the
‘ ‘
caused
specimen
head
of the
of
with
dislocation
was
CLINICAL
fractures
Monteggia
able
to
that
reported
Under
the
collect
by
general
and
and
most
on the
an
graphically.
to assess
the
above-elbow
At the
the
illustrative
nearly
hand
stability
cases
with
flexed
and
complete
of treatment
shown
the
and
patient
In
pressure
elbow
radio-ulnar
in Figures
to be achieved
1 2-1 3).
by
supination-it
radius
without
By
fracture
\Vhether
was
ulna.
of tile
supinating
the
forearm
13).
two
years
which
the
author
corresponds
of these
cases
lying
the
was
supine
most
of the
patients
deformity
of
When
the
full
the
final
was
radiographed
The
After
in three
with
as follows:
abducted
were
at
taken
exception
was
completed
had
confirmed
rotational
are summarised
both
one
reduction
was
been
reduced
with
position
results
held
forearm
reduction
head.
the
were
supination
ulna;
necessary,
radial
and
joint.
arm
radiographs
has
roughly
management
over
applied
the
reduction
dislocated.
last
Lateral
the
and
was
by strand
(Figs.
reduced
(Fig.
incidence
in supination.
direct
of the superior
are
in
pronation.
plaster
end
the
of tile
ilead
reduced
an
90 degrees.
dislocation
and
and
gives
investigation
and
elbow
radio-ulnar
was
by traction
secured
The
mid-rotation
superior
reduction
Naylor.
This
strand
to
radius
MATERIAL
uncommon
eleven.
anaesthesia
shoulder
in supination,
the
are
only
expect
was
head
radial
easily
of the
in supination.
“
tile
the
slowly
experiments
radius
interesting
head
complete.
one would
home
it was
the
to rupture
in the
dislocation
in pronation
the
began
force
screwed
I)rOduced,
continued
to become
consistently
and
pronation
capsule
by a pronation
observed
was
as pronation
dislocation
the
or not,
the
fracture
and
of its joint.
in pronation
“
first
allowing
are caused
This
EVANS
a Monteggia
fractured
split,
supination.
the
always
suddenly
If these
by
in which
cases
ulna
M.
been
radio-
positions
in Table
14 to 32.
TIlE
JOURNAl.
OF
BONE
AND
JOINT
SuRGERy
II
PRONATION
INJURIES
OF
TABLE
A
SUMMARY
OF
ELEVEN
CASES
OF
THE
583
FOREARM
II
PRONATION
INJURY
OF
THE
F’OREARM
I
Case
- Age
Injury
\V. I C.
Mechanism
Monteggia
Simple
Result
Reduction
Unknown
Supination
Union
joint
of
stableulna.
Radio-ulnar
Supination
Union
Radio-ulnar
of ulna.
joint
stable
upination
Normal
_)60
F.
D.
Simple
17
J.
P.
3
4
tram.
Fell
fromExact a
mechanism
unknown
Monteggia
J
J.
\V.
62
Simp le
Monteggia
Knocked
down
by car.
Fell n
to outstretched
hand
8
Simple
Monteggia
Fell off bicycle
on
to
outstretched
hand
5
Simple
Monteggia
R. M.
Supination
and
pressure
I
Fell
Exact off bicycle.
mechanism
unknown
Compound
6
J.
Fell
from
within.
Monteggia
G.
at
side
95
45(.S
95
Union
of ulna.
Radio-ulnar
joint
stable
Open
tion
at reductwo
w e e
s
a n d
supination
Neutral
5
Supinatior
30
)
2
Range
of Rotation
Pronationpronation
side
Injured
rota-
pressure
head
of
Radio-ulnar
Union
of ulna.
subluxation
Union
a nond
radius
play.
Supination
l0
,)
oo
90
30
of ulna.
Radio-ulnar
joint
stable
Union
Mechanism
unknown
:
Ful1
Fu1l
of ulna.
)
Radio-ul#{241}ar
joint
stable
(
120
120
.
Union
7
6
Unknown
Monteggia
Simple
of ulna.
Supination
Radio-ulnar
joint
stable
Full..)
Fracture
third
Superior
8
B. M.
lower
radius.
radioulnar
Radius
plated.
Radio-ulnar
reduction
in
full supination
Fell on to hand.
Mechanism
unknown
dislocation
Union
of
radius.
Radiou mar
joint
stable
,)
ioo
I
50L.
100
-
Anterior
K. 9 P.
_
Unknown
5
Supination
Stable
head dislocation
of radius
Ful1
Fuli
B. 10W.
10
Stable
Caught
twisted
machine
rotated
pronation
superiorradlo-ulnar
radial
Separation
and
anterior epiphy;is
dislocationupper
)Oiflt
Open
supinationin reduction
full
J.
Simple
Monteggia
3
ioo
times
-__
11
E.
sleeve
into
hand
fullin
andround
body
seyeral
Union
.
Unknown
Sup
of ulna.
ination
joint
stable
Radio-ulnar
Full_)
The
ranges
of
rotation
measurements
VOL.
31
B,
movement
were
NO.
4,
taken
NOVEMBER
are
with
1949
shown
Patrick’s
as
one
goniometer,
would
see
but
them
mid-rotation
when
is
‘‘Full
examining
a
recorded
as
patient.
0 degrees.
The
584
E.
FIG.
14
M.
FIG.
EVANS
15
FIG.
16
1. W. C., aged
forty-nine
years.
Fracture
of tile
ulna
witil
anterior
dislocation
of
the head
of the radius.
Figure
14 shows
the
position
in full
pronation
and
Figure
15
in mid-rotation.
Reduction
was secured
only after
full supination
with long-axis
traction
(Figure
16).
Note
how
the ulnar
fragments
fell together
in this
position.
Case
FIG.
Case
joint
1, continued.
was
stable
17
FIG.
Eight
in
weeks
all
positions
mid-rotation;
later
the
of
fracture
rotation:
Figure
18
FIG.
was
united
Figure
17,
19, full supination.
THE
and
full
JOURNAL
tile superior
pronation;
OF
BONE
19
radio-ulnar
Figure
AND
18,
JOINT
SURGERY
PR()N.\i’ION
20
FIG.
Case
of
F. J
3.
the
radius
failed
to
. ,
FIG.
sixty-two
aged
in full pronation
achieve
reduction,
(Fig.23).
Ill
INJURIES
three
fllollths,
years.
OF
21
Monteggia
longest
the
period
superior
of
fracture
(Fig.
Ofl tile
immobilisation
radio-ulnar
joint
585
FORE.RM
FIG.
Anterior
(Fig.
20).
Full sul)ination
but with
direct
pressure
tile
TIlE
22
FIG.
with
21),
head
was
even
of
tile
in this
stable.
fllaxilllal
with
radius
series,
23
of the
displacement
lollg
axis-traction
reduction
tile
ulna
was
ilad
hea(l
(Fig.
22),
cOmpiete(l
united
amid
I
I
I
24
FIG.
Case
ilead
6.
of tile
subcutaneous
Figure
26
and
VOL.
the
31
J.
aged
(;.,
radius.
border.
shows
tile
superior
B,
FIG.
NO.
seven
Tile
upper
Figure
reduction
radio-ulnar
4,
NOVEMBER
years.
25
fragment
of
24 shows
tile
by
1949
tile
fracture
of
uina
penetrated
the
26
ulna
with
anterior
tile
skill
anteriorly,
was
position
in full Pronatiofl
and
Figure
full
supination.
Eight
weeks
later
the
stable
in all positions
of rotation:
Figure
was
stability
secured
joint
FIG.
Compound
in full
promiation.
FIG.
27
dislocation
well
away
25
in
fracture
27 shows
of
the
the
from
mid-rotation.
was
that
united
there
E.
FIG.
Case
9.
without
in plaster.
M.
E\’ANS
28
Fmo.
29
K. P.,
aged
five
years.
A
case
of anterior
dislocatmon
of tile
fracture
of the
uina
(Fig.
28).
Reduction
was
obtained
b’ supination
Eight
weeks
later
the
reduction
was
stable
in
all
positions
head
of
and
of
the
radius
immobilisation
rotation
29).
(Fig.
t
I
Case
of the
operation,
10.
B.
tipper
tile
Vt’., aged
end
of
superior
tell
the
years.
radius
radio-uinar
Severe
witll
pronation
separatioll
dislocation
FIG.
31
FIG.
injury
of
could
tile
be
of
capital
reduced
the
right
elbow.
epiphvsis
only
JOI’RNAI.
30
supination
(Figs.
in
full
OF
32
Anterior
hoNE
.\Nl)
dislocation
and
31).
(Fig.
JOINT
At
32).
SURGERV
PRONATION
INJURIES
OF
THE
587
FOREARM
ANALYSIS
Several
1)
In
achieved
nine
by
When
the
may
points
of
closed
Two
the
radial
the
observed
one
limb
were
by
and
full
submitted
vision
radial
the
In one
for
supelior
forearm
was
its
pronated.
FIG.
34
be
more
13. M.
seventy-one
with
displacenlent
and
forward
the tuberosity
of tile radius
showed
Because
the
reduction
of the
head
Three
3)
the
late
31
end
open
B,
was
age,
of treatment
reduction
fracture
was
twelve
NO.
4,
of the
sound
the
fracture
separation
reduce
was
in
two
of the
In
dislocation
both
was
weeks
epiphysis
cases
reduced
of
it
was
by
full
and
the
been
was
superior
limited
was
radiographs
had
35
unusual
case
of fracture
of the
ilead
(Fig.
33).
tile
upper
radial
fragment’was
radius
needed
full
supination
All
union
joint
in
performed
10
three
and
(Case
the
perfect
4), there
and
was
positions
In
slight
(Fig.
the
forward
34).
plated.
(Fig.
was
showed
radius
view
of
first
stable
supination
position.
was
rotation
was
fracture
joint
degrees
of the
lower
The
in neutral
rotational
in
third
antero-posterlor
the
radio-ulnar
only
stable
of
3).
full.
thai
one
in ten
case
subluxation
of rotation.
ulna
weeks.
NOVEMBER
years.
dislocation
tilat
of the
pronation
radio-ulnar
in all positions
The
in plaster
there
patient’s
superior
of the joint
4)
aged
later
the
At
the
which
VOL.
,
months
Despite
cases
to
complete
________
33
FIG.
8.
twice.
position.
i_Lgl-,
Case
was
only
necessary
to
replacement.
radio-ulnar
was
required
usually
case
wide
diSlocation
was
appeared
in this
there
performed
the
the
other
radio-ulnar
head
was
reduction
to operation.
was
that
superior
on
immobilised
; in the
when
of the
supination
case
accordingly
failed
recurred
pressure
successful,
operation
direct
and
reduction
direct
exceptional
was
reduction
head
supination
in
patients
closed
cases
and
was
but
and
2)
eleven
methods
manipulation
mid-rotation
and
the
closed
dislocation,
old
be emphasized:
1949
united
in all cases
and
the
maximum
period
of immobilisation
in
588
E.
5)
In ten
normal.
out
In the
of eleven
case
patients
in which
the
the
radial
M.
EVANS
final
range
of elbow
epiphysis
was
movement
replaced
at
was
approximately
operation
(Case
10),
the
final range
of rotation
was much restricted.
This case is particularly
interesting
because
of
the history.
The patient
was a boy aged ten years
who caught
the sleeve
of his coat in the
rollers
of a machine.
His forearm
was pronated
with such force that he was picked
up and
whirled
round twice before
falling
to the ground.
CONCLUSIONS
1 Anterior
dislocation
forced
pronation
injury.
of the
.
2.
Full
surest
supination
I wish
to
against
thank
Mr
for
reduction,
recurrence
C. C.
Department
and
Mr Gill of
of the illustrations.
of the
is essential
safeguard
of the
head
Jeffery
for
of Anatomy,
the
of the
his
help
University
Photographic
radius
with
and
immobilisation
fracture
of the
ulna
in full
supination
is a
is the
deformity.
in
the
preparation
of Birmingham,
Department
or without
of
the
of
this
paper
; Professor
for his co-operation
Birmingham
in the
Accident
Hospital
C.
F.
V.
Snout
experimental
for
the
work;
preparation
REFERENCES
EVANS,
Bone
E.
and
M.
(1945)
: Rotational
Deformity
Surgery,
27, 373.
FITZGERALD,
F. P. (1947)
: Treatment
the Royal
Society
of Medicine
(Section
NAYLOR,
A. (1942):
Monteggia
Fractures.
J.
PATRICK,
Forearm
SPEED,
(1946):
J.
S.,
and
WISE,
Bone
study
of
Journal
BOYD,
H.
of the American
WATSON-JONES,
of
A
Fractures.
Journal
edition,
in
Fractures
of
both
Bones
of
the
Forearm.
Journal
of
Joint
R.
(1943):
Supination
of Bone
B.
(1940):
Medical
of Displacements
of the Distal
of Orthopaedics),
40, 488.
British
Journal
of Surgery,
and
Joint
and
and
with
Surgery,
Treatment
28,
of Fractures
Association,
Fractures
Pronation,
Radio-uinar
29,
especial
Joint.
Proceedings
of
323.
reference
to
the
treatment
of
737.
of Uina
with
Dislocation
of Head
of Radius.
115, 1699.
Joint
Injuries.
Edinburgh:
E. &
S. Livingstone,
Ltd.
Third
2, 520.
R.
A.
and
(1941):
Joint
Lateral
Surgery,
Dislocation
23,
of
the
Head
of
the
Radius
with
Fracture
of the
Ulna.
Journal
JOINT
SURGERY
379.
THE
JOURNAL
OF
BONE
ANB