FRACTURES OF THE SCAPULA. 
499 
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 unfavour¬ 
able in working animals, and especially in horses. 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 the burrowing of pus in the fascia of 
this region, though compound fractures implicating the spine only 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 pedal bone, 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 then occurs 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. 1 
Treatment. Displaced fragments must, as far as possible, be replaced, 
which is easiest with the patient in the prone position and under chloro¬ 
form. 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 diseased limb quiet, and especially when weight can¬ 
not be borne on it, early slaughter is preferable to treatment, with its 
doubtful results. Animals which will lie down should have a thick straw 
bed, otherwise they may be placed in slings, and kept as quiet as possible. 
If in compound fractures treatment be resolved on, attention should first 
be directed to rendering the wound aseptic, and to keep it so, a dressing 
is indispensable. 
1 Cadiot and Dollar’s “ Clinical Veterinary Medicine and Surgery,” p. 430. 
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