FRACTURE. 
‘ 
the place which the head of the bone ought to occupy. 
The fhoulder is not fo prominent as nets ae nd the. acro- 
mion feems to form a preternatural projection. ‘The limb is 
allio len bain 
On. the contrary, when the neck of the bone is fraGhured 
there is no o alteration in the fhap pe of the fhoulder ; the acro- 
mion doe 
ia. the 
rough - of the low: er so t may ieee be felt; ar nm : 
thefe cir cane. there is that almoft dec 
ie pee ac a 
Before proceeding to foeak ae the fenenient of fractures 
‘of the humerus, we > thall make a few remarks on fuch inju- 
os brachii is fometimes fraCtured 
in fuch a way, that a logeudia folution of continuity di- 
-wides the two condyles other, and, extending 
pward ed another tranfverfe or 
oblique esi which aff eae v hole thicknefs of t 
,» there are fee different pieces of bone, a 
In certain jaflanses: fractures of the lower end of the os 
‘brachii are of a more fimple defcription; for the divifion 
‘may be oblique, and run down in the diveBion outward, or 
inward, fo as to extend acrofs one fide of the lower end of 
Ake bone, and reach into the joint, thereby detaching a 
one of the condyles from the body of the bone. It is 
Baaun for the internal condyle os broken, without ce 
racture havin ng any communication whatioever with the ca- 
‘yity of the joint. 
‘When the bone is fo broken, as to be fplit into three por- 
with a feparation of both condyles, the deformity is 
greater, andthe fractured part more moveable than in the 
5 On making aes either on the front or 
z 
0 
cm 
gy 
QP 
ad 
rr 
ice 
Lace} 
ct 
= 
io} 
, ee? 
[<) 
feo} 
ch 
~“ 
‘taat fromeach other, and the ned part of the arm ene 
1€ patient commonly keeps his ae ina 
dtate of pronation; and the practitioner, on. tak hold of 
both condyles at ye aad ir pate them in ones direc- 
tions, bane eel a manifeft c 
NV y one one ‘le is detached, the furgeon may alfo 
Feel a grating on moving the feparated fragment; but the 
deformity is much lefs Sane 
In ordinary fractures of the humerus,the firft duty of the 
{urgeon, is to put the ends of the broken bone into as even 
a peat ion with regard to each other as circumitances will al- 
dow. owever, when the folution of continuity is tranf- 
xerfe aad fituated low down, the reader already knows that 
it often: eee that the fragments are little if at alk dif. 
lac 
as It was once the cuitom to pla ice the arm at a right angle 
with the body ; but this method, being found difadvantage- 
ous, it was abandoned’; and’ modern practitioners now unk 
verfally ae the preference to that pofition in which the arm 
lies in the direStion of the trunk. “Such pofture is found to 
be lefs irkfome to the patient, and the a of the fr ae 
are lefs apt to be diiturbed, fince there i 
move. the limb out of that pofition during, the whole of the 
. Itiscultomary, alfo,. to advife the patient to go to ns 
and to remain there for the firit few days.. on as the 
patient is in bed, no time is to be ~ before a furgeon jets 
about reducing and putting up the 
road, {urgeons direét. one ail eed . ‘take hold of the 
writ and make the requifite degree of extenfion, while an: 
other grafps the upper part of the os brachii, and the practi- 
gra 
a hiretelf endeavours with his sk to make the ends 
. % 
£ the fracture lie as {mo 
oo, we are in 
for we bend the elbow-joint in the apply 
our extenfion and counter-extenfion Senet to the lower 
and ral portions of the broken bone 
ult alfo remark that tractures of the humerus feldora 
egree a extention 
n reduced and put into an even 
. {tate of coaptation, the next ii cir is to keep tt quietly 
mu uni 
in fuch condition, until a frm u 
bone to the other has taken piace. 
The means empioved for a purpofe are, a piece of t 
emplaitrum faponis, a roller, {plints well ii ned with foft 
eer anda fling for the fupport of the fore-arm and 
vand. 
The integuments in the vicinity of the fraCture have com- 
ian appliec to them two pieces of the foap-plafter, which 
toge ether oe to extend all ro und ae linb. "This method 
is prefera ith one larger piece, 
which, in ne of cle etter he place, might not 
yield fufficiently to oe the unpleafant ale ics like- 
ly to arife from any undue preffure on, and confinement of, 
the member in this circumftance. 
The roller is next to.be eae from the elbow up to “ts 
armpit, inthe common wa y, the practitioner taking care 
not to make the bandage too ee 3a thing which could do 
eae and might be productive of pain and other bad ef- 
C 
It is plain that the preceding parts of the apparatus are 
more ufed for the fake of neatnefs and appearances than for 
ay particular efficacy. The moft ufeful means are the 
fplints and fling. 
Four ‘oan is ufually enployeds 3 viz. One ont the infide 3 
one on ‘he one on the back; and another on the 
fore-part of “the arm. 
the acromion to the outer condyle ; i thei inner one, from the 
margins of the axilla to - int he back one, 
e down to the sean ; and the 
me height down to the bend of the 
bad eerteate ACES 0 of their preffure on the foft 
parts are to be prevented, by placing betwist ‘{kin, and 
the infide of the inftrumcnts, pal made ¥, or wool, 
Compreffes ought alfo to be uted for eens ae ends cf 
the {plints from chafing the margins of the axilla, 
ar place where the patienteels. uneafinefs from. a (an 
one portion of the 
7 aUrr € part 
.e 
"Splint 6 _ lal longitudinal joints, and_ lined with lea- 
ther, are eod ones for Gat ures Of the humerus, 
When the inflruments are too long, and none of. the proper 
tnefs are at h urgeon casi lg off as 
erat of each fplint wb ich ie feleéts as is neceffar 
The fplints being all arranged in their olga lacs, the 
practitioner maintains them fo with three or four bits s of 
tape, doubled into as jeu nooles, one i diferent parts 
of the limb, and tied in bov 
Many ta Sui very prepay innot truiting entirely to 
t to become flack after a little w hile, fo 
as to allow t Such practi. 
tioners, w. ith great Pr udence, appy. a roller over the fplints, 
aid es enthe tapes, if they ar wi 
motion of ys . enjoin, = of os radius, would 
prodice a difturbance of a 
e fore-arm ina 
th ing, and keep pi pete at relt. 
fling fhould not prefs A cho too fo 
rcibly ee — 
