Atlas and epitome of traumatic fractures and dislocations . g. 61). (c) Fracture through the Tuberosities (FracturapertuberciUaris, Kocher).—A transverse fracture of thehumerus at the level of the tuberosities is produced^ as arule, by a blow or a fall on theouter side of theshoulder. Thedisplacement isthe same as infracture of thesurgical hasbeen treatment isbased on thesame principlesas that of frac-ture of the sur-gical neck, tak-ing due accountof the injury tothe muscular insertions, which is apt to be severe. (d) Traumatic Epiphyseal Separation at the UpperEnd
Atlas and epitome of traumatic fractures and dislocations . g. 61). (c) Fracture through the Tuberosities (FracturapertuberciUaris, Kocher).—A transverse fracture of thehumerus at the level of the tuberosities is produced^ as arule, by a blow or a fall on theouter side of theshoulder. Thedisplacement isthe same as infracture of thesurgical hasbeen treatment isbased on thesame principlesas that of frac-ture of the sur-gical neck, tak-ing due accountof the injury tothe muscular insertions, which is apt to be severe. (d) Traumatic Epiphyseal Separation at the UpperEnd of the Humerus (Plates 33 and 34).—This injury,owing to its relative frequency, is of the greatest practicalimportance. It is, of course, only possible before ossifi-cation of the so-called epiphyseal cartilage, or, better, in-termediary cartilage, has taken place,—i. e., in youngpersons,—and is produced by a fall on the shoulder or thearm. To understand its mechanism it is necessary toknow the anatomic details of the epiphyseal line (see Plate 11. Fig. 61.—Showing the patient in bed. Ex-tension with the elbow flexed; counterexten-sion across the chest. 162 FRACTURES AND DISLOCATIONS. 33, Fig. 1, and Toldt, Anatomischer Atlas, Fi^s. 250-254). The symptoms are often quke characteristic; they pointto a separation of the bone similar to that which occurs infracture of the surgical neck. The outline of the shoul-der is preserved as the head of the bone is in its normal position. In moderate displace-ment abnormal mobility andcrepitation may sometimes bemade out below the upper frag-ment; when the patient is underanesthesia, the head can some-times be fixed firmly with thefingers. The crepitation is softerthan that usually observed in frac-tures; it is the so-called cartilagecrepitation. The displacement isfrequently well marked, the dia-physeal extremity being displacedforward and inward and produc-ing a circumscribed, almost an-gular prominence, best seen byinspection fr
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