American practice of surgery : a complete system of the science and art of surgery . d with it shortening of thelimb. Erichsen says that in this fracture thehead of the bone is not in line with the axis ofthe limb. The prognosis, according to Hamilton,is good so far as bony union is concerned, butmore or less ankylosis is likely to result. The reduction of this fracture may requirea general anaesthetic. Such, however, is notusually the case. A dressing similar to that rec-ommended for separation of an epiphysis shouldbe applied. Some surgeons treat this fracture byimmobilization of the joint a
American practice of surgery : a complete system of the science and art of surgery . d with it shortening of thelimb. Erichsen says that in this fracture thehead of the bone is not in line with the axis ofthe limb. The prognosis, according to Hamilton,is good so far as bony union is concerned, butmore or less ankylosis is likely to result. The reduction of this fracture may requirea general anaesthetic. Such, however, is notusually the case. A dressing similar to that rec-ommended for separation of an epiphysis shouldbe applied. Some surgeons treat this fracture byimmobilization of the joint and traction by sus-pending the wrist in a sling and hanging a weightfrom the elbow for extension. The dressing>hould be changed frequently, and massage employed at the end of two weeks,care being taken not to move the joint for three or four weeks. Immobilizingmay be necessary for six weeks, especially in impacted fractures. Fractures of the Surgical Xeck.—Fractures of the surgical neck involve theportion of the bone between the site of the epiphyseal junction and the inser-. Fig. 32.—Shows Method of Ap-plying Internal Angular Splint andShoulder Cap in Fracture of theSurgical Xeck of the Humerus. FRACTURES. 127 tions of the tendons of the pectoralis and teres major muscles. They are quitefrequent, especially in advanced life, and are usually transverse, sometimesoblique, and always complete; they may be impacted. (Fig. 32.) They may be produced by either direct or indirect violence, and by muscu-lar action. A frequent cause is a fall onthe outstretched hand. The symptoms are mobility, deform-ity (Fig. 33), shortening, flattening of theshoulder, crepitus, and pain running downinto the fingers. The latter symptomis produced by pressure of the upper endof the lower fragment on the brachialplexus of nerves in the axilla. The flat-tening differs from that of a dislocationin that it is located farther below theacromion process. The head of thebone can be felt in the glenoid ca
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