. A practical treatise on fractures and dislocations . ards, and sometimes it is carried upwardsand backwards, following the action of the rhomboideus major. In cases of comminuted fracture, and occasionally in simple frac-tures, the direction of the displacement is reversed, or altogetherchanged, so that the lower fragment instead of being in front is behindthe upper fragment, and instead of overlapping, the two fragmentsare more or less drawn asunder. These are deviations which are noteasily explained, but which depend, perhaps, rather upon the directionof the blow than upon the action of th
. A practical treatise on fractures and dislocations . ards, and sometimes it is carried upwardsand backwards, following the action of the rhomboideus major. In cases of comminuted fracture, and occasionally in simple frac-tures, the direction of the displacement is reversed, or altogetherchanged, so that the lower fragment instead of being in front is behindthe upper fragment, and instead of overlapping, the two fragmentsare more or less drawn asunder. These are deviations which are noteasily explained, but which depend, perhaps, rather upon the directionof the blow than upon the action of the muscles. In a few cases there is no displacement in any direction, althoughthe crepitus with mobility sufficiently demonstrates the existence otafracture. Prognosis.—If displacement actually has taken place, it will be foundvery difficult, as we shall see when we come to consider the treatment,to hold the fragments in apposition, until a cure is completed: so thatthey are pretty certain to unite with a degree of overlapping, or Fractures of thebody and acromionprocess of the scapula. FRACTUEES OF THE BODY OF THE SCAPULA. 207 Lonsdale, Lizars, Chelius, Nelaton, Gibson, Malgaigne, and othershave spoken of the difficulty or impossibility generally of keepingthese fragments in place. Nelaton and Malgaigne, indeed, confess thatthey have never succeeded; Gibson declares that it is scarcely possible;while Chelius affirms, that if the fracture is near the angle the cure isalways effected with some deformity. But then it is not probable that the patient will ever suffer anyserious inconvenience from this irregular union of the fragments, sincethe perfection of its function depends less upon any given form or sizethan in the case of almost any other large bone; and if, as has beenobserved by Lonsdale, the free use of the arm is not recovered for sometime, or if, as has been noticed by B. Bell, a permanent stiffness results,these should be regarded as due to the in
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