500 



of Paris is applied to cover the shoulder, a portion of the thorax and back, and the arm down to 

 the external condyle (Scudder). The arm, with the elbow slightly forward, is bandaged to the 

 side. In some cases a splint is placed between the axillary pad and the inner side of the arm. 



In fracture of the shaft of the humerus below the insertion of the Pectoralis major, Latissimus 

 dorsi, and Teres major, and above the insertion of the Deltoid, there is also considerable 

 deformity, the upper fragment being drawn inward by the first-mentioned muscles, and the 



lower fragment upward and outward by the Deltoid, pro- 

 ducing shortening of the limb and a considerable promi- 

 nence at the seat of fracture, from the fractured ends of the 

 bone riding over one another, especially if the fracture takes 

 place in an oblique direction. The fragments may be 

 brought into apposition by extension from the elbow, and 

 are retained in that position by adopting the same means 

 as in the preceding injury, or by the use of an internal 

 angular splint with three short humeral splints. 



In fractures of the shaft of the humerus immediately be- 

 low the insertion of the Deltoid, the amount of deformity 

 depends greatly upon the direction of the fracture. If it 

 occurs in a transverse direction, only slight displacement 

 takes place, the upper fragment being drawn a little for- 

 ward; but in oblique fracture the combined actions of the 

 Biceps and Brachialis anticus muscles in front and the 

 Triceps behind draw upward the lower fragment, causing 

 it to glide over the upper fragment, either backward or for- 

 ward, according to the direction of the fracture. Simple 

 extension reduces the deformity, and the application of an 

 internal angular splint and three short humeral splints will 

 retain the fragments in apposition. Care should be taken 

 not to raise the elbow, but the forearm and hand may be sup- 

 ported in a sling. 



Fracture of the humerus (Fig. 374) above the condyle deserves very attentive consideration, 

 as the general appearances correspond somewhat with those produced by separation of the 

 epiphysis of the humerus, and with those of dislocation of the radius and ulna backward. If 

 the direction of the fracture is oblique from above, downward and forward, the lower fragment 



FIG. 373. Fracture of the surgical 

 neck of the humerus. 



FIG. 374. Fracture of the humerus above 

 the condyle. 



FIG. 375. Fracture of the olecranon. 



is drawn upward by the Brachialis anticus and Biceps in front and the Triceps behind; and 

 at the same time is drawn backward behind the upper fragment by the Triceps. This injury 

 may be differentiated from dislocation by the increased mobility in fracture, the existence of 

 crepitus, and the fact of the deformity being remedied by extension, on the discontinuance 

 of \vhich it is reproduced. The age of the patient is of importance in distinguishing this form 

 of injury from separation of the epiphysis. If fracture occurs in the opposite direction to that 



