As a result of our experience with a fairly extensive series of severe war injuries to the elbow joint, several guiding principles can be offered.

1. A careful objective examination of each patient must cover nerves, blood vessels, muscles, joints, and bones.

2. Healing of the wounds must first be obtained, the optimum position for stability and function, and the importance of preserving motion whenever possible always being kept in mind.

3. Early splint-thickness skin grafts are often needed to cover granulating surfaces. Later, full-thickness flaps may be substituted, to replace scar tissue and to permit reconstructive surgery.

4. Renmoval of all exuberant bony masses around the elbow is an aid in promoting function.

5. Surgery should be performed step by step, after it is ascertained each the that all tissue reaction has subsided, and the results of previous steps have been appraised. Conservatism is well rewarded, on the whole, for nature performs remarkable recoveries.

6. For each anatonmical displacement about the elbow, a special type of reconstructive surgery is indicated.

7. Much of the normal elbow structure—such as the olecranon, the coronoid, the external condyle, and the head of the radius—may be lost or removed in individual cases without too seriously affecting function.

8. A careful follow-up program of physical and occupational therapy is necessary to obtain good results.

9. The primary measure of usefulness of an injured elbow is stability, so that the forearm and hand may have strength. A moderate range of motion, including rotation of the forearm, provides added basic usefulness.