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Related post: motion at the elbow was at right angles to the forearm, it devi-
ated correspondingly from the transverse axis of the condyles,
passing through them at a level lower on the Tamoxifen 10mg inner than on the
outer side. A displacement of the internal condyle upward, or
of the external condyle Breast Cancer Tamoxifen downward, their attachments to tlie ra-
dius and ulnar remaining unbroken, would annul this outward
deviation of the forearm and bring the latter into line with the
arm or even incline it to the inner side, and, as the breadth of
the condyles was not great, a comparatively slight displacement Buying Tamoxifen
might be sufficient to effect this change. This was the " gun-
stock deformity.'' It. was hardly noticeable when the elbow was
flexed, but was very obtrusive and ungraceful when the elbow
was extended. In the case of fracture of the internal condyle
the displacement of the fragment could be readily occasioned by
pressure upward against the flexed elbow, the pressure being
transmitted to the condyle through the olecranon. Such press-
ure was produced when a posterior rectangular splint was used
with a sling that passed under the elbow and was short enough
to take the weight of the entire limb. If the limb with a simi-
lar splint was supported only at the wrist, this Tamoxifen Cre undesirable press-
ure was not made, for the arm carried the splint, n^t the splint
the arm. Spasmodic contraction of the flexors and extensors
of the forearm might also Tamoxifen Tablets make this pressure. In the case of
fracture of the external Tamoxifen Nolvadex condyle the mechanism of displacement
downward of the fragment was not clear.
The indications for treatment were reduction of thedis|)lace-
ment, if it existed, by pressure upon the frairments, or by abduc-
tion of the extended forearm until its outward deviation was
equal to that of its fellow, and then immobilization by dressings
that would not reproduce the displacement. The importance of
immediate and complete reduction of such displacement as might
exist when the case came under observation was such that,
whenever reasonable doubt existed as to the extent of the dis-
placen)ent or the completeness of the reduction, an auEesthetic
should be given.
In supracondylar fracture, in which the usual displacement
was of the lower fragment backward and upward, permanent
traction was generally necessary to Generic Tamoxifen overcome muscular action.
This might Buy Tamoxifen Citrate be effected by vertical suspension of the limb, the
patient being kept in bed, or by a weight suspended irom the
upper part of tlie flexed forearm while the patient was erect.
The former method was open to the objection that it permitted
an angular displacement. It was, however, of use in the first
fortnight after the injury.
In intercondyloid fracture with marked separation there was
no measure to maintain reduction, and lirnitati'-n of motion was
to be expected. Experience with compound fractures in which
the shifting of the fragments could be recognized by sight and
touch had impressed the author with the exceptional difficulties
attendinff this class of fracture, and he had on one occasion felt
constrained to pass a long steel pin transversely througli both
condyles and the long projecting end of the upper fragment, for
in no other way could they be kept in apposition. Nolvadex Tamoxifen Plaster of
Paris used during the first week was dangerous, unless made so
loose that it was useless as a support. He preferred a broad
heavy posterior splint extending from the axilla to Buy Cheap Tamoxifen the hand and
covering about two thirds of the circumference of the limb, the
elbow being flexed at a right Liquid Tamoxifen angle; while hardening, this could
be so molded by pressure about the elbow as to maintain the
fragments in place. Traction by weight could be used as in a
supracondylar fracture.
In fracture of either condyle the habitual method of treat-
ment was by a Tamoxifen Cancer posterior rectangular splint of metal or plaster,
with the substitution, in many cases, of plaster incasenient dur-
ing the second week. The forearm was supported across the
chest Tamoxifen Citrate by a sling at the wrist What Is Tamoxifen within, not outside, the splint, and
the dressing should be worn for about a month. 4 Hydroxy Tamoxifen It had
seemed to the author that imraobilizatioa in full extension of
the elbow, though presenting certain disadvantages which
would prevent its general acceptance, might be advisable for
the first ten days Tamoxifen Breast Cancer or so if the patient were kept in bed, then
substituting flexion at a right angle, hoping by that time the
fragment would have contracted adhesions preventing its easy
displacement upward.
With fracture of either condyle there was sometimes asso-
ciated dislocation of the bones of the forearm and the fragment
from the humerus. This complication was more frequent with
fract'ire of the internal condyle, Order Tamoxifen Online the dislocation being backward
and upward and the head of the radius resting behind the ex-
ternal Tamoxifen Citrate Buy cond.vle. Under such circumstances retention might pre-
sent special difticulties, and they appeared to be best met by
immobilization with the elbow flexed well within a right angle.
Carefully conducted massage might also be employed.
The extreme limit of time for the wearing of a splint should
be about six weeks for the s^^upracondyljid and intercondvloid Purchase Tamoxifen Online
fractures, and about four weeks for the fracture of either con-
dyle. After the removal of the splint the limb Tamoxifen Mg should be for a
few days supported in a sling and exercised in light movements.
If the motion gained was slow, it might be hastened by carrying
a weight, or by other mechanical aids.
An animated discussion followed, in the course of which the
speakers were unanimous in their appreciation of the thorough-
ness of the author's paper. The points at issue were, as nsual,
the relative merits or demerits of the flexed and extended posi-
tions and the resort to early passive motion as against protracted
immobilization.
Retroperitoneal Tumors, their Anatomical Relations,
Pathology, Diagnosis, and Treatment, with Report of
Cases. — This was tlie title of a paper by Dr. Albeht Vandek-
TEER, of Albany. He said that as our experience in abdominal

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