The practice of surgery . Fig. 558.—Outline of shoulder in case of fracture of clavicle. We have taught ourselves to beheve that traction, countertraction,and manipulation will secure coaptation of the fragments. Sometimes 874 IVIINOIt SURGERY—DISEASES OF STRUCTURE we are justified in our faith, hut at the best it is hard or impossible tohold the fragments in position. The following method has long beenin use at the Massachusetts General Hospital and produces a fairlysatisfactory result: The hand, forearm, and elbow are bandaged firmly;a V-shaped pad (with the apex of the V ii^ the axilla) con
The practice of surgery . Fig. 558.—Outline of shoulder in case of fracture of clavicle. We have taught ourselves to beheve that traction, countertraction,and manipulation will secure coaptation of the fragments. Sometimes 874 IVIINOIt SURGERY—DISEASES OF STRUCTURE we are justified in our faith, hut at the best it is hard or impossible tohold the fragments in position. The following method has long beenin use at the Massachusetts General Hospital and produces a fairlysatisfactory result: The hand, forearm, and elbow are bandaged firmly;a V-shaped pad (with the apex of the V ii^ the axilla) constructed ofsheet-wadding is fitted beneath the arm; and a shoulder-cap of wire orplaster of Paris is fitted over the whole shoulder and down the aiTn tothe external condyle of the lumierus. The arm is then bandagedfirmly to the side and the forearm is hung in a sling. Other similar methods are sometimes more effective, though theymay be cumbersome and Fig. 559.—Fracture of the upper end of the humerus. Note hand, forearm, andelbow bandaged evenly and without compression; axillary pad and strap (Scudder). Whatever the apparatus used, we find that it is continually difficultto hold the fragments in place. The dressing must be removed fre-quently and regularly—at least once a week—so that the surgeon mayinspect the limb and correct malposition, if possible. He must lookout also for pressure sores, and will do well to have the shoulder andarm massaged each time the arm is exposed. At the end of two or threeweeks soft union should take place; and fairly firm union in from fourto six weeks. These fractures of the surgical neck are excellent examples of frac-tures suitable for the open treatment. Delayed union, or non-union, isnot uncommon. Perfect apposition without operation is almost impos-sible. I, therefore, recommend wiring the bones in the case of personswho are not old or afflicted with any serious organic disease. SPECIAL F
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
