THE SCAPULA 43 



the fractured bone may be felt, the biceps is relaxed and its belly- 

 bulges forwards. 



In cases of fracture through the glenoid cavity diagnosis is much 

 more difficult, on account of the. manner in which the articular surface is 

 protected (see chapter on joints). Some assistance, however, may be 

 derived from pressure exerted upon the front of the joint with the 

 palm of the hand, when it will be found that the upper extremity 

 of the humerus may be much more easily pressed backwards. At times 

 during the process crepitation may also be detected. 



Fracture through the constricted portion above the coracoid process, 

 on the other hand, is readily diagnosed, on account of the greatly increased 

 mobility of the part. The limb can now be readily abducted and 

 adducted. In addition to the fractured bone, considerable damage is 

 inflicted upon the numerous arteries which cross this part of the 

 bone. 



The two last-mentioned fractures are the most serious, and recovery 

 is so rare that in the majority of cases slaughter is the only course 

 to be advised. 



In the treatment of fractured coracoid process the apparatus designed 

 by Bourgelat provides probably the best means of maintaining the 

 fractured piece in position after it has been elevated by manipulation. 

 This apparatus is made up of " a light band of iron, bent to fit over the 

 withers and shoulders, and reaching as far as the lower part of the 

 scapula, each of its ends terminating in a wide oval ring corresponding 

 to the scapulo-humeral articulation; and a plate of sheet iron, concave 

 and shaped so as to fit on the point of the shoulder. The oval rings 

 have four screw-holes to receive as many thumb-screws. These screws 

 are sufficiently long to pass through the holes in the rings into the plates 

 inside which they are riveted in such a way that they are still movable. 

 It will thus be seen that the apparatus exercises pressure on both scapulas 

 at the joints and beyond them, this pressure being increased or decreased 

 by means of the screws." 



