. Annals of surgery . ternal rotation is much limited. The shape of the shoulder is good,the deltoid well nourished, and head of the bone is so closely unitedto the scapula that there is no slipping in any position, and all move-ments are effected with considerable power. The patient is doingheavy work and the arm is gaining strength. There is some atrophyof the infraspinatus and supraspinatus muscles, which may be due todisuse, as it appears to be diminishing. Neither these muscles northeir nerves were directly involved in the injury to the joint or in theoperation. 298 B. FARQUHAB CURTIS. (D
. Annals of surgery . ternal rotation is much limited. The shape of the shoulder is good,the deltoid well nourished, and head of the bone is so closely unitedto the scapula that there is no slipping in any position, and all move-ments are effected with considerable power. The patient is doingheavy work and the arm is gaining strength. There is some atrophyof the infraspinatus and supraspinatus muscles, which may be due todisuse, as it appears to be diminishing. Neither these muscles northeir nerves were directly involved in the injury to the joint or in theoperation. 298 B. FARQUHAB CURTIS. (D) Reduction by Open Arthrotomy,—Free incision upon thedisplaced bone, and opening the joint for the purpose of re-duction is such a modern operation that Poirier and Mauclairein their essay in 1892 do not even mention it among the meth-ods of treatment. It is an American operation, for as early as1859, in the first edition of his System of Surgery (Vol. ii,p. 194), the great Gross strongly urged immediate arthrotomy. Fig. 3.—Showing facility of internal rotation. in these cases when attempts at reduction otherwise had {Archives generales de medecine, 1888, p. 450) also sug-gested it as an adjuvant to the ancient method after the frac-ture had been consolidated. Stemen {journal of the MedicalSciences, Fort Wayne, Ind., 1893, Vol. xiii, p. 170) appears tohave been the first to cut down upon the displaced head in acase of recent injury. FRACTURE-DISLOCATION OF HUMERUS. 299 His operation was done in 1870, and he reduced the head,and secured a good result. Porter did a similar operation in theyear 1893, and McBurney followed in 1894. The last-namedsurgeon invented a useful instrument shaped like a boot-hook, the point of which could be inserted into a hole boredin the upper fragment, while the powerful handle allowed trac-tion and even rotation to be executed easily. In 1895 camemy first case. In 1896, Berger, of Paris, and Bull each operatedupon a case. Wolfler i
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