Dr. Richard G. McCollum: The patient is a 43-year-old farmer who sustained an injury to his right arm when he fell from a hayloft approximately 10 feet above the ground, landing on his hands with his arms in extension. He noted immediate pain in his right elbow and wrist, and was taken to a local hospital. Roentgenological studies there revealed a dislocation of the right elbow with fracture of the radial head and a severely comminuted fracture of the distal radius. A posterior splint was applied, and the patient was transferred to the Emergency Ward at the Massachusetts General Hospital.
Thorough physical examination revealed abnormalities only in his upper extremities. The right elbow was markedly swollen and held in 30° of flexion. The olecranon was quite prominent posteriorly and laterally, and the patient resisted active and passive motion of the elbow. There was also tenderness and swelling of the right