Fracture of the coracoid process is rare. It may result from direct violence, such as the recoil of a gun, but it is more often an accompaniment of dislocation of the shoulder or of the lateral end of the clavicle upward. As the coraco-clavicular ligaments usually remain intact, there is no displacement; but when these are torn the coracoid is dragged downwards and laterally by the combined action of the pectoralis minor, biceps, and coraco-brachialis muscles. Crepitus may be elicited on moving the fragment. Separation of the epiphysial portion of the coracoid may occur up to the seventeenth year.
The treatment consists in placing the arm across the front of the chest, to relax the muscles causing the displacement, and retaining it in that position by a sling and roller bandage.
Fracture of the Upper End of the Humerus
It is most convenient to study fractures of the upper end of the humerus in the following order: (1) fracture of the surgical neck; (2) separation of the epiphysis; (3) fracture of head, anatomical neck, or tuberosities.
Fig. 27.—Fracture of Surgical Neck of Humerus, united with Angular Displacement.
Fig. 28.—Impacted Fracture of Neck of Humerus, in man æt. 75.
(Sir H. J. Stiles' case. Radiogram by Dr. Edmund Price.)