11. If judiciously managed, art readily removes all the accidents attendant on this fracture; but, if otherwise, the consequences are apt to prove troublesome. It is here, much more particularly than in other places, that all deformity of the part ought to be prevented; because, the neck of the humerus being near to the centre of the motions of the arm, will very essentially impede those motions if it be not properly reunited. A deformed callus has been known to produce, in the hollow of the arm-pit, a protuberance, which has, in part, prevented abduction, and appeared to keep up an habitual swelling in the limb.
It is, then, from the perfection of the apparatus, and not from the vicinity of the injury to a joint, that the prognosis is to be formed, both as to the consequences, and as to the duration of the fracture. Keep the fragments in exact and regular contact, and there will be no obstacle to that success which seldom forsook Desault.
§ V.
OF THE REDUCTION.
12. The reduction in this case is usually attended with but little difficulty, and the great multiplicity of means hitherto used for that purpose, demonstrate only the barrenness of the art.
Most of the machines destined to reduce the luxation of the humerus, have been applied to this fracture. Thus the ladder,[11]* the door,† and the club,‡ placed under the arm-pit, served at once the purposes of counter-extension, and conformation, while the powers for producing extension were applied to the elbow, and more rarely to the wrist. Thus Hippocrates recommended a wooden cross, the effect and mode of action of which are nearly the same. These means, in general, besides being insufficient, are liable to a further objection, in consequence of their acting on the edges of the pectoralis major, latissimus dorsi, and teres major, which being thus forced upwards, draw the fragment to which they adhere in the same direction, and thereby constitute an obstacle to the reduction. (See what will be advanced on the subject of luxations of the humerus.)
13. To machines succeeded the use of straps, weights suspended to the limb, &c. These processes were entirely useless, in as much as they were intended only to increase the natural powers of the operator, which are already more than sufficient of themselves. They will, therefore, in a short time, exist only in the history of surgery.
Petit proposed to reduce this fracture, by first raising the arm to a right angle with the body, and then directing one assistant to make the requisite extension, by taking hold of the elbow with his hands, while another grasped the point of the shoulder, for the purpose of counter-extension. This method was attended with the threefold inconvenience, of subjecting the patient to great fatigue and pain, of weakening the extending powers, by bringing them too near to the point required to be moved, and of irritating the muscles that draw the lower fragment upwards, and thus exciting them to contract. Hence the difficulties sometimes attendant on reduction, which is always simple in itself, when, after the trunk is properly fixed, gentle extensions are made by taking hold of the fore-arm in a half-bent state. The following is the mode of reduction practised by Desault.
14. The patient is seated either on a chair or on the side of a bed. The arm is slightly separated from the body, and carried a little forward.