40 SURGERY. 



three weeks. In many individuals, the tip of the acromion process 

 is slightly movable, being merely united by ligament. 



The neck of the scapula is rarely fractured, and it is liable to be 

 mistaken for a dislocation ; the shoulder falls ; there is a hollow be- 

 low the acromion, from a sinking of the deltoid muscle ; and the 

 head of the humerus can be felt in the axilla. It can be recognised 

 by the facility with which the parts are replaced, the falling of the 

 head of the bone into the axilla, when the extension is removed, and 

 by crepitation. 



Treatment. — The first point is to carry the head of the humerus 

 outwards, and the second to raise the glenoid cavity and arm. The 

 former is effected by a thick cushion confined in the axilla by a 

 bandage, and the latter by placing the arm in a short sling. Ten 

 or twelve weeks are necessary to procure union, and a still longer 

 time to recover the strength of the arm. 



The coracoid may be fractured by direct violence ; the process is 

 drawn downwards, by the action of the coraco-brachialis, pectoralis 

 minor and biceps muscles. There are pain, swelling, and crepita- 

 tion in the part, and loss of power in the limb. 



Treatment. — This consists in making the fingers of the injured 

 limb touch tiie shoulder of the opposite side, the position being 

 secured by bandaging. 



The body of the scapula may be fractured either vertically or 

 transversely, and there is but little displacement, unless it is near 

 the lower angle of the scapula. When the angle is frcictured, it may 

 be drawn forward and upward. 



Treatment. — This consists of a tight roller around the chest; the 

 arm being placed in a sling, 



FRACTURE OF THE CLAVICLE. 



This fracture is frequent, and is usually produced by violf^nce 

 upon the shoulder, arm, and hand. It is generally oblique, and near 

 the middle of the bone ; the part is painful and swollen, and every 

 attempt at motion produces pain ; the shoulder is sunken, and drawn 

 towards the sternum, and the acromial fragment is drawn down- 

 ward by the weight of the arm, and forward and inward by the 

 action of the subclavius muscle. The patient usually supports the 

 arm with his other hand, to relieve the pressure upon the axillary 

 plexus of nerves. The indications are plain, viz. : to elevate the 

 shoulder ; to keep it outward from the chest ; and to draw it slightly 

 backward. 



Treatment. — The mode of dressing this fracture is extremely 

 various. DessauWs ajrparatus consists of a compress placed over 

 the fracture, a wedge-shaped pad placed in the axilla, and retained 

 by a roller which surrounds the chest. The elbow is to be brought 

 to the side, and the arm and chest surrounded by circular turns of a 



