. A practical treatise on fractures and dislocations . by this accident depends upon the extent of laceration of a ligament which passes from the under part of the spine of the scapula to the glenoid cavity. If this be torn (and to this we ought to add the ligaments passing from the coracoid process to the clavicle and acromion process) the glenoid cavity and the head of the os humeri fall deeply into the axilla, butthe displacement is much less if thisremains whole. The usual signs are, a depressionunder the acromion process, the sameas in dislocation of the head of thehumerus downwards, but
. A practical treatise on fractures and dislocations . by this accident depends upon the extent of laceration of a ligament which passes from the under part of the spine of the scapula to the glenoid cavity. If this be torn (and to this we ought to add the ligaments passing from the coracoid process to the clavicle and acromion process) the glenoid cavity and the head of the os humeri fall deeply into the axilla, butthe displacement is much less if thisremains whole. The usual signs are, a depressionunder the acromion process, the sameas in dislocation of the head of thehumerus downwards, but not so deep;the head of the humerus felt, perhaps, inthe axilla; crepitus, and the immediaterecurrence of the displacement when-ever, after the reduction has been fairlyaccomplished, the arm is left unsup-ported. The crepitus is best discoveredby resting one hand upon the top of the shoulder in such a manneras that a ringer shall touch the point of the process, while the arm isrotated and moved up and down by the opposite hand. It may also14 Fig. Fracture of the neck of the scapulacording to A. Cooper. 210 FRACTURES OF THE SCAPULA. be easily ascertained that the coracoid process moves with the humerusinstead of the scapula. Occasionally, the accident is accompaniedwith paralysis of the arm, from pressure upon the axillary nerves, anda rupture of the axillary artery is also mentioned by Treatment.—The indications of treatment are three, namely, to carrythe head of the humerus, with the glenoid cavity, &c, up, to carry itout, and to confine the body of the scapula. The first is accomplishedby a sling, the second, by a pad in the axilla, and the third by abroadroller carried repeatedly around the arm and chest and across theshoulder. § 3. Fractures of the Acromion Process. Examples of fracture of the acromion process have been reportedby Duverney, Bichat, Avrard, A. Cooper, Desault, Sanson, Nelaton,Malgaigne, West,2 Brainard,3 Stephen Smith,4 and others. I havemyse
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