THE SHOULDER-GIRDLE. 



243 



Fracture of the Outer Third of the Clavicle. Attached to the outer third 

 of the clavicle on its under surface, extending not quite to its end, are the coraco- 

 clavicular (conoid and trapezoid) ligaments. The conoid inserts into the conoid 

 tubercle near the posterior edge of the clavicle, while the trapezoid is broader and 

 passes from the conoid tubercle outward and anteriorly not quite to the extremity 

 of the bone (see Fig. 267). The bone may be fractured either through the part to 

 which the conoid and trapezoid ligaments are attached, or between them and the end 

 of the bone, a distance of about 2 cm. (4 in.). The line of the fracture is either 

 transverse or inclines backward and outward (see Fig. 259). 



The displacement of the outer fragment is downward and inward. If the fracture 

 is through the ligaments the displacement is not marked. If beyond the ligaments, 

 the shoulder drops, carrying down the outer fragment, and the inner fragment may 

 be elevated slightly above the outer one, but the up-and-down displacement is not 



Pectoralis minor 



Pectoralis major 



Latissimus dorsi 



Teres major 



FIG. 259. Fracture of the outer end of the clavicle. The outer fragment is drawn inward by the pectoralis major 



latissimus dorsi, and teres major muscles. 



conspicuous. In many cases the anteroposterior displacement is very marked and 

 peculiar. The outer fragment is bent sharply inward at the site of fracture, producing 

 a deformity which is pathognomonic. It is caused by the curved shape of the bone at 

 this point, by the weight of the arm, and by the action of the muscles passing from 

 the shoulder to the trunk, especially the pectoralis major (see Fig. 259). 



Treatment. As the deformity is not very marked any of the usual bandages, 

 such as those of Velpeau, Desault, or posterior figure eight are fairly satisfactory. 



FRACTURES OF THE SCAPULA. 



While fractures of the scapula are not common, there are a few anatomical facts 

 in reference to the scapula and its muscles which are worth calling attention to. 



The scapula is liable to be fractured more or less transversely through the body 

 below the spine; the acromion and coracoid processes have been broken; it has also 

 been fractured through the surgical neck, and the glenoid process has been chipped off. 



