Case. J. M*** Est*** falling on his elbow, fractured the neck of the humerus. A surgeon was immediately called, who, finding a depression beneath the acromion, a protuberance in the hollow of the arm-pit, and the humerus directed outwards, pronounced, without further examination, that there existed a luxation in a downward direction. Wishing to reduce it immediately, he employed, to no purpose, the common processes. Acute pains were the consequence. The opening in the capsule being too narrow was irritated, and the member subjected to great violence of motion. At length the pains became insupportable; the operators gave over their fruitless efforts, and Desault was called.
He discovered the mistake from the immobility of the head; from the depression beneath the acromion being lower down than in a luxation; and from the existence of a crepitation. A reduction was effected without loss of time; the apparatus was applied, but in the evening a considerable swelling occurred around the arm-pit; soon afterwards inflammation was superadded; a vast collection of matter succeeded, and, notwithstanding the utmost attention, it was five months before the patient was restored to health.
9. To this example, I could add others, where the most serious accidents have resulted from a similar mistake. It must be acknowledged, however, that, if, in a fracture, the displacement be inward and a little forward, the greater part of the signs herein detailed (5) apply equally to a fracture and a luxation: but then, as we have just seen in the preceding case, the immobility of the head, the place of the depression beneath the acromion, and the crepitation, will remove any doubts that may be excited in the mind of the surgeon, by the protuberance in the arm-pit, the direction of the arm, &c. &c.
§ IV.
OF THE PROGNOSIS.
10. A fracture of the neck of the humerus assumes, in general, a character not very troublesome; and if, as Heister says, “a fracture near the head is worse, and more difficult to be cured,” this is less owing to the nature and seat of the disease, than to the difficulty of keeping the fragments in contact.
Seldom have the reunion of the bone, and the removal of all the disagreeable effects accompanying the accident, required a longer time than is necessary for the cure of other fractures. The numerous examples, which occurred in the Hotel-Dieu, during Desault’s direction of the surgical department, confirm the truth of this assertion, notwithstanding some doubts that may have been raised respecting it, by prejudices formerly entertained, on the subject of fractures in the vicinity of joints.
From twenty-six to thirty days are sufficient for the reunion: this was the term commonly required in the Hotel-Dieu.