52 SURGERY. 



breathing follows. Reduction can be effected by deep inspiration, 

 slightly bending the body backwards and making some pressure 

 on the projecting point. The subsequent treatment is the same as 

 that for fracture of the rib. 



DISLOCATION OF THE CLAVICLE. 



The clavicle may be dislocated at either extremity, and is more 

 rare than fracture. 



The sternal end may be dislocated upward, backward, and for- 

 ward, fTg. 10. When dislocated upward, the sternal extremity 

 approaches its fellow, and is much more elevated than the acromial 

 extremity. When dislocated backward, which is more rare, there 

 is a depression over the articulation, pain and stiffness in the neck, 

 and difficulty of swallowing. When the direction is forward, which 

 is the most frequent, it is produced by force appHed at the opposite 

 extremity. It is characterized by a projection over the spot, inclina- 

 tion of the head to the affected side, pain upon moving the arm, and 

 the shoulder is brought near to the chest. 



The reduction is easy, — by means of extension and counter-ex- 

 tension ; there is more difficulty in preventing a recurrence of the 

 accident. Dessault's apparatus for fractured clavicle should be 

 applied. But even with the greatest care, greater or less deformity 

 commonly remains, which, however, does not interfere with the 

 motions of the arm. 



The scapular end is generally dislocated upwards. Although 

 sometimes it shdes beneath the acromion. It is usually the result 

 of a fall ; and is recognised by pain, impeded motion, depression of 

 the shoulder, and the clavicle resting on top of the acromion occa- 

 sions a projection. 



Reduction is effected by elevating the shoulder and depressing the 

 corresponding end of the clavicle. Dessault's bandage is then to be 

 applied, and the part kept at rest. Some displacement usually re- 

 mains, which does not prevent motion of the shoulder. 



DISLOCATION OF THE ARM. 



This is the most frequent dislocation, on account of the mobility 

 of the shoulder joint, its constant exposure to injury, and the shal- 

 lowness of the glenoid cavity, compared to the size of the head of 

 the humerus. 



It may be displaced in three directions; viz., inwards, downwards, 

 and backwards. In dislocation inwards, the elbow stands out from 

 the body, and is inclined a little backward ; a protuberance is felt 

 beneath the pectoralis major muscle, and there is frequently shorten- 

 ing of the limb. 



In dislocation downwards, which is the most common displace- 

 ment, the arm is lengthened, and there is great rigidity and 



