A practical treatise on fractures and dislocations . y at about the fifteenth year. All theother centres remain cartilaginous until from the fifteenth to the sev-enteenth year, when ossification commences, and is completed bya common union among all parts, usually between the twenty-secondand twenty-fifth years. No doubt, however, a fracture of this process does occasionally takeplace. In addition to my own, I have already mentioned severalother examples, some of which have been confirmed by dissection;and in the case mentioned by Stephen Smith, an autopsy, made threeweeks after the accident,
A practical treatise on fractures and dislocations . y at about the fifteenth year. All theother centres remain cartilaginous until from the fifteenth to the sev-enteenth year, when ossification commences, and is completed bya common union among all parts, usually between the twenty-secondand twenty-fifth years. No doubt, however, a fracture of this process does occasionally takeplace. In addition to my own, I have already mentioned severalother examples, some of which have been confirmed by dissection;and in the case mentioned by Stephen Smith, an autopsy, made threeweeks after the accident, showed a fracture without displacement, theperiosteum covering its upper surface not being torn; the fragmentcould be turned back as upon a hinge. Prognosis.—The process generally unites with a slight downwarddisplacement. This occurred in at least two of the examples seen byme; but in such cases the motions of the arm are not in consequencemuch, if at all, embarrassed; unless, indeed, it is so much depressed 210 FRACTURES OF THE SCAPULA,Fis. Scapula, with epiphyses. (From Gray.) as to interfere with the upward movements of the arm; a result whichHeister erroneously supposed was inevitable. Sir Astley Cooper says that a true bony union is rare in these frac-tures, and that there generally results a false joint, the fragments unitingby a fibrous tissue; but sometimes the surfaces, instead of unitingeither by bone or ligament, become polished, and even eburnated. Malgaigne has noticed, also, in a specimen contained in theDupuy-tren museum, a hypertrophy of the lower fragment, this portion havinga diameter nearly twice as great as that of the portion from which itwas detached. Symptoms.—Where no displacement exists, the diagnosis mustalways be difficult, if not impossible. In such a case we could onlybe instructed by the manner in which the injury had been received,by the contusion, and by the presence of mobility or crepitus. In examples attended with displacement, if no
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