FRACTURE 
| by the irregularity whicli is generally produced i in the courfe 
of a nee procefs. A crepitus is likewife per- 
cepti 
the body of the feapula is fra€tured, the nature of 
ee 
the — is ufually made smaraar plain by oe 
tus whic the fh and a 
& 
both fides, they are hardly ever difplac 
The treatment of meas of the a prefents the 
fame indications which accompany fractures in general. In 
longitudinal and tranfverfe eee of the body ror the bone 
empla ftrum 
a 
“a 
os 
fo) 
™ 
a 
Pe 
— 
oO 
2 
8 
Fs 
° 
s 
w 
fo} 
ne in a motion ae ated $ an object whieh can only be ac- 
d enting the arm itfelf from moving. 
es neceffary to confine the humerus clofe to 
the fide, by aor ying a roller round it and the body to- 
gether, from the fhoulder to the elbow 
e have remarked, that when the ‘lower angle of the 
an is broken, the fragment becomes drawn ‘downward 
and forward by the ation of the ferratus major anticus 
mufcle. Hence, it is proper to sae he teapala Caan 
Ing | arm itfelf down- 
t fhould - confined 
aif a 
and the fragment of bone be . t as much upward 
backward as poflible, by means of” proper compreffes 
cad a bandage. 
en the acromion. is fractured, the aCtion of the deltoid 
voufcle tends to draw downward and outward the detached 
portion. The t treatment confilts in raifing the arm fuffi- 
siently to make the head os brachn force the outer 
f the acromion upward, a 
may be eff by applying a roller round the arm an 
trunk toget Te and putting compreffes and a bandage on 
the fcapula. 
“There is an ps He alfo, in making the head of the 
os brachii fan out, on bringing the elbow clofe to 
the fide; and fe was Ww ith this view that Default was in the 
habit of placing a fmall pillow in the arm-pit, before he 
bound the arm and body aes Ww sae the roller, 
The treatment of fractures of the ceraccid ptocefs con- 
fts in bringing the os brac chi at rowan s the fternum, 
and plucing the fhoulder downward and forward, fo as to re- 
x the muicles which have the power of cence the frag- 
n fhould be kept in the pofition which we 
A roller'may be nfed 
for keeping the fhouldey down W and and forward, and fome 
' ufe.may be derived fron placing a eomprefs juft under the 
detached piece of bon 
When the neck of the feapula is fractured, the cued 
cavity and the — a the upper ex — fall fo muc 
ownward as to on the appeara of a difloc ation. 
‘The plan which fen Gages ao scaly to follow inthis 
caie, is to raife the os brachii {ufiiviently to bring the exter. | 
* an oblique one, 
rial piece of the neck of the fcapula into contaé with the in= 
ternal one. The limb and glenoid cavity fhould then be pre- 
vented from falling’ se again by fupporting the elbow and 
fore-arm in a proper Ax piece of the emplaftrum fa- 
ponis and:a {pica pada are next applied by the generality 
practitioners. But amore ufeful fep is to prévent all 
motion of the fhoulder ner arm, by bi os brachii 
clofe to the fide with a ro 1 
ept in a quiet edd which is highly favourable to the union 
of all broken bon 
Fraélures of the Humerus, or Os Brachii. 
It is remarked by furgical writers that fractures of the hu- 
merus are very feldom difplaced in the longitudinal direétion 
a sca when He ee of continuity is fituated at the 
lower a al a ta the brachialis: internus be 
a 
cg 
3 
so 
Co 
Q 
} 
> 8 
pa} 
4.08 
pos} 
the fracture er above 
the infertions of the deltoid and ‘coraco-brachialis mufcles. 
If we confider the a¢tion of thefe mufcles, and the manner 
in which the latiffimus dorfi, pectoralis major, and other, 
mufcles exert themfelves, we fhall difeover in fuch powers 
many cafes to difplace the frafture, particularly when it is 
as is often the cafe. 
All oblique fraétures of - os brachii are generally dif- 
placed, whenever the part of the bone in w vhich the tide 
of continuity has a cg above the middle. The v 
per furface of the fracture “a then unfitted for ening ; 
an effeétual mechanical refiftance to the afcent ofthe lower 
one, the latter éafily glides upwz i and rides over the former, 
on being drawn in fach direction by the action of the del- 
toid, biceps, coraco-brachialis, and long portion of the tri- 
iv) 
oO 
ae 
The humerus is fubje& to saan at every part, fro 
the head to the condyles of the . When the seni of 
continuity happens above = inferion of the pe 
jor; latifenue dorfi, and te or mufcles, faeeon call 
it a fracture of fle. ae of ae ha umerus, an expreffion 
which does not ftrictly accord with the idea which anatomiits - 
- give us, of what ener Properlyt to be regarded as that t part of 
hen 
the bone. 
lar contraétion which feparates the head fro: nthe tuberofi-_ 
ave ju 
The nee Fpmptoms attendant on fractures of the ie , 
merus are, achange in the direction, and a fhorteni ning of the - 
limb 3 a difting& ar oiae on moving the lower portion of the ' 
oka bone ; seanen pine a whigh is mater a ey increafed © 
i the ufe of the lmb is loft, © 
ra ne con ° 
he diagnofs of per Aare af the os brachii: is . 
ciently plain ; it is only when the neck of the bone is broken - 
that any obfcurity is likely to prevzil, and that there is i 
probability of miftaking the cafe for a luxation of thé-fhoul- . 
der. A little refle€tion will foon qualify any Pee nee cone to ; 
avoid error ; for the differenees of the two cafes are c 
fiderabl 
Fr: AG es of the neck of the a are attended with, 
a ie fon at a upper and outer par 
e head of the bone is dillocated into ie axilla a, 
* deep 2p hollow may ane felt immediately under the acrcaacr, 1 
