18 Proceedings of the Royal Society of Medicine 10

Recurrent Dislocation of Left Elbow of Ten Years' Duration Treated by Kapel's Operation.-F. E.
WEALE, M.B., B.S., for H. E. HARDING, F.R.C.S.
T. H. C. S., male, aged 33.
Past history.-First dislocated his left elbow in 1942. It was reduced, and he was free from trouble
until 1951. The elbow re-dislocated as he was putting his coat on; this recurred on five occasions,
but he was able to reduce it himself without difficulty. No relevant family history.
On examination.-A little fluid was present in the joint, and there was some tenderness above the
head of the radius. The X-rays showed a normal olecranon fossa, and a thin flake of bone anterior to
the elbow-joint. Manipulation under anasthesia confirmed the ease with which the joint could
be dislocated.
27.2.52: Operation. Elbow approached through anterior and posterior incisions, as described
by Kapel (1951), and straps of triceps and biceps secured as shown in Fig. 1.

FIG. 1.-Diagramn of operation (after Kapel). A, Suture pulling strap of triceps through hole in humerus to
coronoid process; B, suture pulling strap of biceps in opposite direction, to be fixed to olecranon process.
6.10.53: The patient works as an ambulance driver and stretcher-bearer. There is no loss in
muscular power, no loss in supination-pronation movements and flexion; extension is reduced by
about 20 degrees (Fig. 2). His elbow has not dislocated since his operation.

FIG. 2.-Range of moveinent twenty months after operation.

REFERENCE
KAPEL, 0. (1951) J. Bone Jt. Surg., 33A, 707.

Mr. H. E. Harding said he made no claimns for the operation. He had carried it out for lack of anything
better and somehow it had worked, since the man was reasonably grateful and had returned to his original
employment as an ambulance stretcher-bearer.