. Röntgen ray diagnosis and therapy . the chisel, it was tried to approximate them. This wasmade possible only after the diaphyseal end was shortened. Thehead of the humerus presented a thin bone shell, which could notbe sewed to the diaphysis in the usual manner. The author there-fore excavated the head with the bone spoon still further, trimmingthe diaphyseal end at the same time in such a manner that it fittedinto the excavation. No wiring was done. The fragment could be 326 THE EOxYTGEN RAYS kept in situ by immobilizing the arm in the elevated position by-means of a humerothoracic plaster-
. Röntgen ray diagnosis and therapy . the chisel, it was tried to approximate them. This wasmade possible only after the diaphyseal end was shortened. Thehead of the humerus presented a thin bone shell, which could notbe sewed to the diaphysis in the usual manner. The author there-fore excavated the head with the bone spoon still further, trimmingthe diaphyseal end at the same time in such a manner that it fittedinto the excavation. No wiring was done. The fragment could be 326 THE EOxYTGEN RAYS kept in situ by immobilizing the arm in the elevated position by-means of a humerothoracic plaster-of-Paris dressing. Althoughthere was some swelling, combined with a slight elevation of tem-perature, for the first few days, the wound healed by first inten-tion. The paralytic symptoms have greatly improved, still thereis some loss of power. While, as referred to before, articular fractures often demandearly operative interference, for the purpose of proper reposition,fractures of the diaphyses very seldom require such Fig. 245.—Fracture of Diaphysis of Humerus Associated with Separation of Fragment. It may happen in the multiple type that bone splinters are so farseparated from the fractured area that their reposition is impos-sible. If they, as the Rontgen examination will determine, areliable to offer an obstacle to the functional ability of the limb, theymust be exposed. If there is sufficient periosteal coherence war-ranting proper nutrition of the fragment, it may be replaced andfixed by wiring. If not, it had better be removed. Fig. 245 illustrates the spiral-shaped fracture of the humerusin a stout man, aged forty-six years, sustained by severe violencefour days before the skiagraph was taken (patient presented tothe New York State Medical Association, October, 1902). Theslight shortening of the arm was explained by the juxtaposition of TREATMENT OF DEFORMED FRACTURE .527 the fragments, as is evident from the skiagraph. There was anenormous swelling, w
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