American practice of surgery : a complete system of the science and art of surgery . may be slight or wanting. In fracture of the outer third the lineis mostly transverse, and the displacement may be slight, wanting, or quitenoticeable. The displacement here is generally angular, with the apex directedbackward. When the fracture is external to the trapezoid ligament or at theouter inch of the clavicle, angular displacement is the rule, the outer fragmentlooking forward and inward, until it stands at a right angle with the remainingbone. The fractured surface of the external fragment may lie ag
American practice of surgery : a complete system of the science and art of surgery . may be slight or wanting. In fracture of the outer third the lineis mostly transverse, and the displacement may be slight, wanting, or quitenoticeable. The displacement here is generally angular, with the apex directedbackward. When the fracture is external to the trapezoid ligament or at theouter inch of the clavicle, angular displacement is the rule, the outer fragmentlooking forward and inward, until it stands at a right angle with the remainingbone. The fractured surface of the external fragment may lie against the an- Fig. 26.—Fracture of the Right Clavicle. (Anger.) Ill) AMERICAN PRACTICE OF SURGERY. terior border of the inner fragmenl or under it. Differentiation from a dislo-cation of the acromial end of the clavicle depends much upon the existence ofcrepitus, to demonstrate which, however, may be no easy task. When, how-oxer, fracture takes place inside the attachment of the trapezoid ligament—, between the conoid and trapezoid divisions of the coraco-clavicular liga-. Fig. 27.—Fracture of the Clavicle with Typical Displacement. The site of fracture is at thejunction of the inner and middle thirds of the bone. The inner fragment appears to be drawn upward bythe contraction of the sterno-cleido-mastoid muscle, or pushed in the same direct ion by the outer great pectoral muscle has been partly removed, and the axillary space (considerably narrowed by thedislocated head of the humerus) is thus exposed. The shoulder and arm are depressed. (Helferich.) ment—little or no displacement can be found, because these ligamentous struct-ures hold the fragment well in place. Multiple fractures of the clavicle are. as a rule, due to direct violence. Thebone, however, has been known to break in two places as a result of indirectviolence. When one fracture is at the acromial end and the other at the ster-nal or the middle division, the displacement of the intervenin
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