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Show 126 rnaernaa or THE scartms. ERACTURE OF THE SCAPULA. weight falling on the shoulder, than of, a person pitching WM" 7 . with the shoulder to the ground. ' - -~ ~-,.‘r.. w.»- v-wu- -:;- .a- -~..v,-.-<‘,;ti "(thaw mun ‘ , A, the arm of that side and either pulling it down, or letting it drop with its own weight, an evident sinking of the top of the shoulder ; or on applying one hand to the shoulder, while with the other we move the arm, a crepitation is felt. On pushing up the arm bone, there is pain, and we see the point of the aeromion unnaturally elevated. In fracture of the acromion scapulze (which, by the bye, is not a frequent accident, owing to the weakness of the clavicle) Or the other parts of the scapula, the inferior angle is exposed to be fractured next in degree of frequency to the acromion process. It may be broken by falls or blows. I have been consulted by a person complaining of a great pain in the lower part of the shoulder blade from a fall, and yet I have found that this part never touched the ground or received a direct injury; but had been injured by the sudden action of the latissimus dorsi on the angle of the scapula in we raise the arm, and relax the deltoid muscle, and examine the sudden twist of the trunk, and in the exertion to save and replace the pieces of the bone. Then the arm being allowed to fall gently down, the fore arm is to be suspended in a handkerchief, so that the head of the humerus may be made to push up the extremity of the broken acromion, and preserve it in its place. As this injury proceeds from a direct blow on the part, the pain and tumefaction of the integu~ ments of the shoulder will be great, and no bandage can be applied with advantage until the swelling has subsided : then the spica bandage may be put on. The spica bandage is a form of applying the double-headed roller. The middle of the roller is put under the arm-pit of the oppo« himself from falling. site side; then the ends are brought up and crossed on the top of the wounded shoulder; then they are crossed under the arm-pit of the same side; they are then carri. ed across the back and breast, and the heads of the roller are again crossed under the arm-pit of the opposite side, and so are carried up on the injured shoulder again-and this is repeated until the shoulder and the broken bones are covered with a firm lacing of the bandage. It may be necessary to relax the deltoid muscle, in order to keep the bone in its place. If the acromion be allowed to unite with its point depressed, it will check the motion of the arm bone. I fume-w" «3- - wwwsm- raw . Mr. a 0F FRACTURE OF THE BODY OF THE SCAPULA. If the acromion process be broken, we see on taking hold of There is sometimes a dislocation of the tendon of the latissimus dorsi, in consequence of the angle of the scapula getting over the tendon, so that the arm cannot be carried forward or lifted. When there is fracture of the lower part of the scapula, we have to press the fingers around the lower angle of the scapula, as if to fix it; then, raising the patient's arm, so as to roll the body of the off, it does not follow It is not practicable to the body of the bone; arm, the body of the scapula, if the lower angle be broken the motion of the body of the bone. bring the lower piece to answer to but by managing the position of the scapula may be brought to meet the lower piece, and to come into accurate contact with it. To effect this, we carry the patient's elbow forward on the chest, and when we feel that the parts of the scapula correspond, we place the palm of his hand on the opposite pap and bind the arm to the chest : for this purpose the fore arm is to be slung in a handkerchief, and pads or compresses put betwixt the arm and scapula; and then a broad roller is applied round the body, including both the chest and the arm of the injured side. mew .. vmm @fig_ _ - \|I |
