American practice of surgery : a complete system of the science and art of surgery . ourweeks. The symptoms are pain, increased by rotating the bone, crepitus, andecchymosis; and abnormal mobility can in some instances be detected, espe-cially if the shoulder is steadied and the lower angle of the bone is lifted. If, inthe normal state of the parts, the arm be carried behind the body, the infe-rior angle of the scapula will be tilted to such a marked degree that one mayreadily grasp it. In fracture the tilting will be lessened by the act, and, whenthe angle is grasped and moved, a false point
American practice of surgery : a complete system of the science and art of surgery . ourweeks. The symptoms are pain, increased by rotating the bone, crepitus, andecchymosis; and abnormal mobility can in some instances be detected, espe-cially if the shoulder is steadied and the lower angle of the bone is lifted. If, inthe normal state of the parts, the arm be carried behind the body, the infe-rior angle of the scapula will be tilted to such a marked degree that one mayreadily grasp it. In fracture the tilting will be lessened by the act, and, whenthe angle is grasped and moved, a false point of motion and perhaps crepi-tus will be noted. Careful inspection and palpation over the bone, along thespine and the anterior border, will aid in diagnosis, especially if they be com-bined with moving the inferior angle. The treatment consists of a shoulder cap, or a gutta-percha splint mouldedover the scapula, the arm bound to the side and the hand carried in a sling(Da Costa), or a sling for the arm is often sufficient; a three-tailed piece of 122 AMERICAN PRACTICE OF Fig. 30.—Fracture of the Neck ofthe Scapula. (H. IUeffel, in Le Dentuit Delbet: Trait€ deChirurgie.) strapping, one end carried over the shoulder, and the other two around thechest, is sometimes used to press and fix the scapula against the thorax.(Treves.) Fracture of the surgical neck (Fig. 30) results from a Mow or a fall upon theshoulder, the fragment consisting of the glenoid cavity and coracoid process, with the attachments of the pectoralis minor,the coracorbrachiaiis, both heads of the biceps,and the long head of the triceps muscles. In this variety of fracture the shoulder isflattened, the acromion unduly prominent, thearm lengthened, and the elbow at the side, whilethe lower fragment may be felt as a mass inthe axilla: but the ease with which reductionmay be effected and with which a recurrencetakes place should differentiate the conditionfrom a dislocation. The deformity will disap-pear
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