. Modern surgery, general and operative. thus, the upper end of the lower frag-ment projects into the axilla, and the elbow stands out from the side and holds that the violence drives the lower fragment forward. The upperfragment is abducted, rotated outward, and flexed, which position is due, itis generally taught, to the action of the supraspinatus, infraspinatus, andteres minor muscles. In some cases displacement is forward, and in other casesit is not obvious. The lower fragment may impact into the upper, in whichcase the symptoms are obscure and the diagnosis is made by excl
. Modern surgery, general and operative. thus, the upper end of the lower frag-ment projects into the axilla, and the elbow stands out from the side and holds that the violence drives the lower fragment forward. The upperfragment is abducted, rotated outward, and flexed, which position is due, itis generally taught, to the action of the supraspinatus, infraspinatus, andteres minor muscles. In some cases displacement is forward, and in other casesit is not obvious. The lower fragment may impact into the upper, in whichcase the symptoms are obscure and the diagnosis is made by exclusion. If theimpaction is solid and complete, there are the history of direct force, theimpaired movements, the slight deformity, and the absence of crepitus. In allfractures of the upper end of the humerus the distinction can be made fromdislocation by feeling the head of the bone under the acromion and by notingthat it does not move on rotating the arm. Among complications are fracture Fractures of the Surgical Neck of the Humerus 637.
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