1 8 Anatomy Applied to Medicine and Surgery. 



tinct than they are in the adult, and, when a fracture of 

 the clavicle does occur in childhood the break is generally 

 incomplete, because of the greater elasticity of the osseous 

 tissue and the thicker periosteum of the child, as compared 

 with that of the adult. This is the so-called "greenstick" 

 fracture. 



A child may be brought to the surgeon with a history 

 of a fall and a subsequent inability to use the arm. In 

 cases of this nature, careful examination should be made 

 over the clavicle for any point of tenderness. This ex- 

 amination should be thorough, since, often, the only indi- 

 cation of injury may be tenderness on pressure over a 

 portion of the clavicle, generally the middle, for reasons 

 given above. In children the fracture is, as a rule, incom- 

 plete, hence there will likely be no displacement, and so, if 

 the surgeon, looking for displacement and rinding none, 

 treat the case lightly, the child may be brought back, some 

 time afterwards, with a swelling involving the clavicle 

 trie result of callus formation. Pain, in fracture of the 

 clavicle, may be due to the sharp irregular ends of the 

 fragments pressing on the skin, but, if the pain affect the 

 upper limb, darting down it immediately after the acci- 

 dent, it is probably due to injury of the brachial plexus by 

 the fragments. Should pain in the limb come on some 

 days after the injury is inflicted, it will, likely, be due to 

 callus formation pressing on the plexus, although it must 

 not be forgotten that improper appliances, or imperfect 

 bandaging, may have the same effect. The chief struc- 

 tures behind the clavicle that are liable to be injured in 

 fracture of that bone are, the brachial plexus, the pleura 

 or lung and the subclavian artery or vein, and, although 

 the latter is protected to a great extent by the subclavius 

 muscle, yet, cases are on record in which this vein has 

 been injured, one such case being that of Sir Robert Peel 

 (Ashurst). 



