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Show BRACTURE or THE SCAPULA. 124‘ 1253 FRAC'IURL OF THE ULAVICLL. simple fracture more than can possibly happen after cutting down upon and sawing their ends. But perhaps the patient reasoned better than his surgeon since he would not submit. I still insist on the necessity of absolute rest after such operation for re-union of bone. again bringing the turns to bear on the shoulders, they are retained braced back: after a few yards of the roller are thus applied, the shoulders are fixed, and the arm cannot . fall forward. Now a soft cushion, or pad of lint, is to be placed in the axilla, and the turns of the roller being secured, the end is I‘RACTURE OF THE CLAVICLE. 'l‘nn clavicle may be broken by a blow directly upon it; but it is most commonly broken in consequence of the person pitching on his shoulder as in falling from horseback. The fracture of this bone is ascertained by remarking that r. i i l the shoulder is fallen down towards the breast, and, 011 ‘13:};th "mum ' , p M feeling along the bone, the crepitation of the broken ends is perceived, or the broken ends are found to have passed each other and one of them to ride upon the other. The motion which the patient makes with the greatest difficulty, is to touch the shoulder of the opposite side, or to raise his hand to his forehead: for this motion twists the broken clavicle, and forces the broken ends into the cellular membrane. The indication is to keep the shoulder from falling forward and the arm from dragging. If the patient be drunk, compresses are to be put over the tendons of the pectoralis major, and a figure of 8 bandage to be so applied as to draw the shoulders powerfully back, that no struggling or thoughtless motion be allowed, which might tear the parts against the sharp bones. to be brought down upon the back and outside of the arm, so as to bear on the elbow and brace it to the side. This in consequence of the compress being in the axilla, still further removes the shoulder from the sternum, and keeps the brok. en ends of the bones from passing each other. If the bones come easily into their place, then the pad need not be applied in the axilla until after a time the roller is somewhat loosened by stretching, or it be necessary to make some substitute for the severe bracing of the roller. When the shoulder is braced back, we must notice if the bones be on the exact level. And at all events, it is necessas ry to sling the arm, to prevent the falling down of the outer portion of the clavicle; for this purpose the fore arm is put in a large handkerchief, the ends of which are to be tied. round the neck. No kind of compress must be allowed on the ends of the broken bones, for they are ineffectual as to keeping the bones in their place, and only press the tender skin against the sharp bone. If it be found that the patient is often feeling and pressing the bone, it may be well to put a piece of leather spread with adhesive plaster, over the clavicle, sim~ ply to keep off his fingers. XV hen the bone is to be set, an assistant draws back the shoulder, while the surgeon examines the position of the l-‘RACTUBE OF TIIE ACRUMION PROCESS OF THE SCAPULA. their natural relation, some flat compresses of linen are to be placed as directed before the arm-pits, that the bandage may not cut the skin. The double-headed roller is now to be applied : puttingr the middle of the roller across the back, the surgeon brings two turns under the arm-pits and over the shoulder, then, by crossing the roller on the back and 1 r urn-"5" 'nj- - we". Ffi‘fim-h‘ fin?" . ".4. .4 bones; and when the broken ends have been drawn into Wnnn the shoulder is black and blue, and it is found that the patient has pitched on it, but yet the clavicle is not broken ; and when there is orepitation on pressing the prominent part, and some disfiguration of the shoulder joint, we shall tind that the acromion scapulee is broken. But the fracture 0t the aeromion is even more. apt to be a consequence of a H .-.; I" l | mm W991 |
