2O Anatomy Applied to Medicine and Surgerg. 



prominent symptom of fracture of the carocoid is down- 

 ward displacement when the process is broken off in front 

 of the coraco-clavicular ligament. This displacement 

 would be the result of the action of tihe pectoralis minor, 

 assisted to a slight extent by the short head of the biceps 

 and by the coraco-brachialis, but, when the fracture is sit- 

 uated behind the coraco-clavicular ligament, then the de- 

 pression of the coracoid process would be inappreciable, 

 since it would still be held up by the ligament. , 



When fracture of the acromion occurs in front of the 

 acromio-clavicular joint, i.e., when the tip of the acromion 

 is broken off, there is no displacement of the arm, but if 

 the acromion be fractured behind this joint, then the sup- 

 port, afforded by fhe clavicle, being partly removed, the 

 scapula and arm fall, slightly, downwards, inwards and 

 forwards. The deformity in this case would not be near- 

 ly so pronounced as in a fractured clavicle, although re- 

 sembling it, since the coraco-clavicular ligament would 

 still support the scapula. 



Epiphyseal Separation. It must not be forgot- 

 ten that the scapula is developed from seven centres, two 

 of which are for the coracoid and two for the acromion 

 process ; that the coracoid epiphysis joins the scapula 

 about the age of fifteen, and that the acromial process 

 joins after the age of twenty-two, hence in injuries under 

 these ages, it is advisable to bear in mind that a separation 

 or non-union of the particular epiphysis may be present, 

 rather than a fracture, and one means of distinguishing a 

 fracture of the scapula from epiphyseal separation, the re- 

 sult of arrested development, is that, in the latter case, 

 each scapula would, in all likelihood, present a similar con- 

 dition ; whereas, in fracture, it would be the injured side, 

 only, that would be affected. 



