A system of surgery . (blows and falls upon the shoulder),it may yield before the humerus driven against it; muscular actionhas proved a very rare cause. Small fragments may be broken fromthe tip and outer edge with little deformity; less often the cleft lies FRACTURES OF THE SCAPULA. 807 more or less mesial to the acromio-clavicular joint (Fig. 243), andit would lie here should the epiphysis separate. The signs of the injury are—flattening of the shoulder; difficultyin abduction; irregularity on the subcutaneous surface ; removalof the deformity on pushing up the humerus, mobility of thefragm
A system of surgery . (blows and falls upon the shoulder),it may yield before the humerus driven against it; muscular actionhas proved a very rare cause. Small fragments may be broken fromthe tip and outer edge with little deformity; less often the cleft lies FRACTURES OF THE SCAPULA. 807 more or less mesial to the acromio-clavicular joint (Fig. 243), andit would lie here should the epiphysis separate. The signs of the injury are—flattening of the shoulder; difficultyin abduction; irregularity on the subcutaneous surface ; removalof the deformity on pushing up the humerus, mobility of thefragment, and perhaps crepitus. The usual treatment is a figure-of-8 bandage under the elbow,crossing on the shoulder, and under the axilla on the opposite side,applied so as to raise the humerus. Better than this is Sayresstrapping (Figs. 238, 239), no backward traction being made, and the first stiap being applied after the second, and over all. Unionis usually fibrous, but the result is good. It would be easy to wire. 242.—A Scapula repaired after such a Fracture as is shown in Fig. 244. The lower frag-ment has been drawn forwards by the teres muscles, and lies rather behind the callus has formed, and there is a small gap in the line of union at one or two spots. Fig. 243.—A Scapula showing: (1) A fra-eture of the acromion near the spine; (2) a lissureseparating the whole coracoid process with the upper end of the glenoid fossa and a bitof the upper edge of the blade ; (3) a fissure running from the above into the blade. Fig. 244.—A Scapula recently fractured transversely below the Spine. the fragments, but, unless the arm were kept abducted for a month,the result would probably be no better. Several specimens withouthistories have been shown of separation on both sides of a part ofthis process, with no irregularity or sign of callus, and a plate ofwhat looked like cartilage intervening. These specimens may havebeen due to injury, but were probably examples o
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