FRACTURE OP THE SCAPULA. 39 



FRACTURE OF THE RIBS. 



The ribs are very liable to fracture, which usually is in the mid- 

 dle, when occurring from direct force, or force applied at each end. 

 Displacement is seldom great, and is difficult to detect in fat persons. 

 There is pain, swelling, and difficulty in breathing ; crepitus is felt, 

 when the hand is placed over the part during respiration or coughing ; 

 emphysema appears when the pleura is injured. 



Treatraent. — If there is an angular projection of the extremities, 

 a compress is to be applied over it ; if there is a depression, a com- 

 press is to be placed at each extremity ; the chest is to be surrounded 

 by a roller, in order to prevent respiration by the intercostal muscles, 

 and thus to keep the parts at rest. Inflammation and cough are 

 likely to ensue, and must be treated by antiphlogistic means and 

 anodynes. 



Compound fracture of the ribs is treated of, under the head of 

 Wounds of the Chest. 



FRACTURE OF THE STERNUM. 



Fracture of this bone is rare, on account of violence being neces- 

 sary to produce it ; injury usually is done to the thoracic viscera. 

 The deformity is generally a depression, and the symptoms are great 

 difficulty of respiration, pain, palpitation of the heart, and perhaps 

 spitting of blood, and cough. Caries, or a pulmonary affection, 

 often results from a fracture of the sternum or ribs in scrofulous 

 habits. 



Treatment. — The local treatment consists of a compress and a 

 roller, applied upon the same principles as in fracture of the rib. 

 The general treatment must be adapted to the inflammatory condi- 

 tions of the organs of the chest. Collections of pus and blood be- 

 hind the sternum can be evacuated with a trephine, but the operation 

 is often attended with unfavourable results. 



FRACTURE OF THE SCAPULA. 



The acromion process is sometimes fractured ; the shoulder loses 

 somewhat of its roundness, the head of the humerus falls slightly, 

 and there is a slight depression at the point of fracture. It is distin- 

 guished from dislocation by mobility of the joint, and crepitation 

 can be felt by rotating the head of the humerus. 



Treatment. — It may unite by bone, but generally it unites by 

 ligament. It is to be kept in its place, by elevating and firmly fix- 

 ing the OS humeri ; this is effected by placing a cushion between the 

 side and the elbow, and retaining it by a roller, the elbow being car- 

 ried a little backwards. If the pad be placed in the axilla, and the 

 elbow be brought close to the side, the fragments will be separated ; 

 but little inflammation follows, and bandages may be removed in 



