760 FRACTURES OF THE SCAPULA. 



of the body are most difficult to diagnose, but may always be surmised 

 if crepitation be present whilst the humerus is known to be intact. 



Course and prognosis. The nearer the fracture is to the lower 

 end of the bone the graver the condition. This principle, established 

 by Binz, must be borne in mind ; it rests on the fact that, in fractures 

 of the upper portion of the scapula, the fragments are not so easily 

 displaced, and the pain is less. 



The prognosis of fracture through the glenoid cavity is most 

 unfavourable in working animals, and especially in horses. Anchylosis 

 almost always follows, and in consequence the animal is permanently 

 lame. Fracture near the neck of the scapula does not necessarily 

 prevent the animal again becoming useful, especially if the fragments 

 are not much displaced ; sometimes perfect usefulness is restored. 

 This is oftener the case in fractures of the body, and almost always 

 so in fractures of the spine and upper portions of the scapula, 

 provided they remain subcutaneous. Compound fractures are always 

 dangerous, because of infection extending beneath the fascia of this 

 region, though compound fractures implicating only the spine often 

 heal if sufficient time be given for the separation and discharge of 

 the fragments. The less the pain and lameness the greater the 

 chance of healing ; but when, in horses and cattle, such symptoms 

 are marked, it is better to slaughter the animals unless they are of 

 particular value for stud purposes, as they suffer severe loss of 

 condition during recovery. Marked pain forces the animal to rest 

 entirely on the other foot, and there is then danger of laminitis and 

 descent of the fetlock, especially if the patient stands continually. 

 Increased pulsation in the metacarpal artery, and attempts to rest 

 the foot, point to this complication, which is so painful that the animal 

 generally lies down and cannot be moved. Death may then occur 

 from decubitus. 



In small animals, particularly in carnivora, subcutaneous fractures 

 of the scapula generally unite in four to six weeks, but lameness 

 sometimes remains. In a few cases necrosis of the entire scapula 

 has been seen after fracture. (Cadiot and Dollar's " Clinical 

 Veterinary Medicine and Surgery.") 



Treatment. Displaced portions must, as far as possible, be 

 replaced, which is easiest with the patient in the prone position and 

 under chloroform. In large animals, however, the operation is always 

 difficult, and even when successful does not ensure that the fragments 

 will remain in position. The bandaging and plasters so often 

 recommended are of little use except in small animals. When pain 

 is not sufficient to compel the animal to keep the lame limb at rest, 



