. Modern surgery, general and operative. n. Operation is often necessary if the upper end of the lower frag-ment is displaced to the outer side. If the fracture is complicated by a com-plete dislocation operation is needed to replace the head and fix the partial dislocation may disappear under extension (Ross, Ibid.). Longitudinal and Oblique Fractures of the Head of the Humerus.—Bythis term may be designated separation of the great tuberosity or separationof a portion of the articular surface, together with the great tuberosity, fromthe shaft and lesser tuberosity (Pickering Pick,
. Modern surgery, general and operative. n. Operation is often necessary if the upper end of the lower frag-ment is displaced to the outer side. If the fracture is complicated by a com-plete dislocation operation is needed to replace the head and fix the partial dislocation may disappear under extension (Ross, Ibid.). Longitudinal and Oblique Fractures of the Head of the Humerus.—Bythis term may be designated separation of the great tuberosity or separationof a portion of the articular surface, together with the great tuberosity, fromthe shaft and lesser tuberosity (Pickering Pick, Guthrie, and Ogston). Thecause is usually direct violence to the front of the shoulder, but the greatertuberosity may be torn off by muscular action. The symptoms in longitudinal and oblique fracture of the head are broad-ening and flattening of the shoulder with projection of the acromion. Theupper fragment passes upward and outward, and the lower fragment passesupward and inward to rest on the margin of the glenoid ca\dty below the. 640 Diseases and Injuries of the Bones and Joints coracoid process. The elbow is drawn from the side, there is some shortening,and the patient cannot abduct his arm. If the surgeon grasps the patientselbow and holds it to the side and rotates the arm while with his other hand hegrasps the upper fragment, crepitus is very positive. Examination developswide separation of the fragments. The deformity cannot be entirely corrected,because the biceps tendon is apt to get between the fragments (Ogston), buta useful limb can usually be obtained. Treatment.—The plan which gives the best result in treating longitudinal and oblique fracture of the head of the bone is to place the {)atient on his back upon a hard bed with a small, firm pillow under his head, abduct the arm above the head, rotate it outward so that the back of the hand rests on the bed, and hold it in place by sand-bags. This position should be maintained for three weeks, at the end of wh
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