Apparatus.—1. Axillary pad.
2. Roller, 3 inches wide.
3. Sling.
4. Wool.
Fractures of the clavicle nearly always leave some deformity after union; this is best avoided by keeping the patient on his back on a flat couch with the head alone supported by a cushion, and the arm fixed to the side until union has taken place. As most persons will not submit to a fortnight or three weeks’ confinement in bed for this accident, the fragments must be kept in position as nearly as possible by apparatus while the patient goes about.
The displacement of the outer fragment is inwards, downwards, and forwards. Many varieties of apparatus are employed to prevent this displacement during union; the following mode is perhaps as effectual as any other in accomplishing this object.
Step 1. Fix in the arm-pit a firm wedge-shaped pad of bedtick filled with chaff; 5 inches broad, 6 inches long, and 1½ or 2 inches thick at the thick end, or just enough to fill the axilla and throw out the humerus without compressing the axillary vein, hence the thickness varies with the hollowness of the axilla (see fig. 38). A band and buckle are stitched to the thick end, which is uppermost. When in use, this band is passed over the opposite shoulder and keeps the pad in place. A little wool should be put under the band, where it crosses the root of the neck, to prevent chafing.
Fig. 38.—Wedge-shape pad for broken Collar-bone, attached to the American ring-pad.
Step 2. The elbow is elevated by an assistant, who keeps the arm vertical and lays the fingers on the breast bone. A roller attached to the arm by a couple of turns is carried behind the back round the trunk, and over the arm above the elbow, drawing that close to the side.