A system of surgery . one andpushing the shaft towards the glenoidfossa ; and (c) cutting down on the headand replacing it, or, if this seem un-likely to give a good result, removingit and placing the shaft in the glenoidfossa. In favourable circumstancesthe latter plan would now be chosen. Since the above was written,Clutton has shown an excellent result in a boy in whom, throughan anterior incision, he fixed the head and surgical neck on tothe shaft by means of an ivory peg driven vertically through theformer into the latter; he then reduced the head, and the boyrecovered with a practically
A system of surgery . one andpushing the shaft towards the glenoidfossa ; and (c) cutting down on the headand replacing it, or, if this seem un-likely to give a good result, removingit and placing the shaft in the glenoidfossa. In favourable circumstancesthe latter plan would now be chosen. Since the above was written,Clutton has shown an excellent result in a boy in whom, throughan anterior incision, he fixed the head and surgical neck on tothe shaft by means of an ivory peg driven vertically through theformer into the latter; he then reduced the head, and the boyrecovered with a practically perfect joint. Diagnosis of injuries of the shoulder.—For purposes ofdiagnosis it is well to bring together several of the foregoing injuriesto the shoulder which resemble one another in some respects, andto draw attention to the main points of difference which we shouldendeavour to establish. Accurate diagnosis may be impossible whenthe broken-off fragment is small, the coverings thick, or extravasa-tion Fig. 250.—Treatment of Fracture ofthe Surgical Neck of the Humerusby Erichsens Splint, a piece ofleather or poroplastic of the formshown. The rounded bend at theupper end acts as an axillary pad,and some extension may be bandage should fix the elbowto the side. DIAGNOSIS OF INJURIES OF TEE SHOULDER. 815 The chief injuries to be considered are—the inward dislocationsof the humerus; fractures of the glenoid fossa and surgical neck ofthe scapula; and fractures of the anatomical and surgical necks ofthe humerus (including separation of the upper epiphysis) withoutand with dislocation. The first point is to ascertain the position of the head; if it bein the socket, the shoulder is rounded, the fingers cannot be pressedbeneath the acromion, and they feel the smooth rounded head whenthey grasp the shoulder from before back. But the head is dislocatedif the shoulder be flat, the deltoid tense, and the fingers meet no re-sistance other than that of muscles in p
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