FRACTURE OF THE HUMERUS. 



41 



second roller, whereby Ihe shoulder is elevated and drawn outwards, 

 A third and last roller commences at the armpit of the sound side, 

 and being carried obliquely over the compress, descends the posterior 

 portion ot" the arm, passes under the elbow, and obliquely upwards 

 across the chest to the armpit, whence it started ; then over the 

 back to the shoulder of the affected side, across the compress, down 

 in front of the arm, under the elbow, and across the back to the 

 sound armpit again. This bandage serves to retain the arm and 

 shoulder in its elevated position. 



Fox's apparatus consists of a wedge-shaped pad, secured by 

 strings to a circular collar which surrounds the shoulder of the 

 sound side, and a sling made of linen, which contains the forearm ; 

 it elevates the shoulder, and, by bringing the elbow to the side, draws 

 the shoulder outwards. 



Some use merely a pad and two handkerchiefs, which, if properly 

 applied, can be made to fulfil all the indications. 



Some deformity almost always results. 



FRACTURE OF THE HUMERUS, 



The anatomical neck is the seat of fracture in young persons, and 

 sometimes in old. There is little or no flattening of the shoulder, 

 owing to the head of the bone remaining in its place; the end of the 

 shaft is directed obliquely upwards and forwards, and projects on 

 the coracoid process ; the arm is shortened, and crepitus 

 is distinct after slight extension and coaptation of the Fig. 2. 

 fragments. 



Treatment. — This requires a pad in the axilla, a 

 splint on the fore and back part of the arm, a roller, 

 and a sling for the hand, the elbow hanging free. 



The Surgical Neck. — The upper fragment remains 

 in its place, but its low extremity inclines slightly out- 

 wards ; the upper end of the lower fragment is drawn 

 upwards and inwards under the pectoral muscle, and 

 the shoulder is round, the arm shortened, the elbow 

 abducted, and there is crepitation upon adjustment. 



Treatment. — A pad is placed in the axilla ; two 

 splints secured by a roller ; the hand supported by a 

 sling, and the elbow free. 



Fracture at the Neck may be accompanied with dis- 

 location. This is recognised by the tumour in the 

 axilla, formed by the head of the bone, which does not 

 move when the shaft is rotated. 



Treatment. — Anefibrt should be made-to restore the 

 head of the bone, and then to coaptate the extremities : 

 this is often impossible ; then the extremity of the lower 

 fragment should be brought to play in the glenoid ca- 



4 



