A Treatise on Fractures, Luxations, and Other Affections of the Bones

by P.-J. Desault

Case I. Nicholas Gay, aged twenty-nine, was struck, in passing under a decayed building, by a stone, which, having become loosened, fell on the point of his shoulder. In an instant he experienced severe pain, and a difficulty of moving his arm, particularly upwards. Soon afterwards there occurred a swelling of the shoulder, and a large echymosis at the place where the blow was received. The pain, not so acute during a state of rest, was increased by the motions of the arm, and even by leaning the head towards the opposite side, which latter circumstance was, no doubt, owing to the contraction of the trapezius muscle.

A surgeon being called, judged it sufficient to make use of discutient applications, to which the swelling and the echymosis appeared to yield in the course of a few days. On a more accurate examination, a fracture was discovered, supposed to be in the external part of the clavicle, and for which the patient was sent to the Hotel-Dieu.

The fracture was discovered to be in the middle of the acromion, which it divided transversely. The bandage already mentioned (12) was applied, and, from the first day, the patient was left to his usual regimen. Fifth day, a renewal of the apparatus which had become relaxed: seventh day, a fresh displacement, in consequence of an unguarded motion: a fresh application of the bandage, which continued in its place till the sixteenth day, when it was replaced anew: thirty-second day, reunion complete; a stiffness in the motions of the part, which exercise removed by degrees, and of which the patient felt no remains after the forty-eighth day.

FRACTURE OF THE LOWER ANGLE OF THE SCAPULA.

§ IV.

OF THE SIGNS OR APPEARANCES AND DISPLACEMENT.

14. Next to the acromion, the lower angle of the scapula is that portion of the bone most liable to be fractured. The usual causes of it are, falls on the side, or blows received on the part. It is characterized by a displacement which is always perceptible. On the one hand, the fleshy portion of the serratus-major, which is attached to the inferior fragment, draws it directly forward, while it is drawn upward by the teres-major, and some of the fibres of the latissimus dorsi. On the other hand, the body of the bone itself remains behind, being held by the rhomboid muscles. Hence arises a separation, which renders it difficult to mistake the fracture. Should any doubts still remain, let the shoulder be drawn backwards and the scapula along with it: let the fingers be, at the same time, placed on the lower angle, to ascertain whether or not it follows the motions of the bone; if it does, there is no division: but if, on the contrary, it remains stationary, the existence of the fracture is evident.

§ V.

OF THE REDUCTION, AND THE MEANS OF RETAINING IT.

15. Here, as in all other fractures, the means of reduction must be founded on the causes of displacement. To effect the replacement, therefore, it is necessary, either to push backward and downward, the angle which is displaced in a contrary direction, in order that it may be brought into contact with the body of the bone, or else to draw the body of the bone forward and upward, that it may meet the displaced angle. It is thus, that in a fracture of the condyle, the body of the jaw, is drawn into contact with the fragment.