Remarks upon fractures of the scapula, with cases presenting striking peculiarities : read before the Medical Society of the State of Georgia, at their annual meeting in Augusta, April 8, 1857 / by L.A. Dugas.

  • Dugas, L. A. (Louis Alexander), 1806-1884.
Date:
1857
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Licence: Public Domain Mark

Credit: Remarks upon fractures of the scapula, with cases presenting striking peculiarities : read before the Medical Society of the State of Georgia, at their annual meeting in Augusta, April 8, 1857 / by L.A. Dugas. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    consequently slight, than in cases in which there is ft complete solution of continuity in the periosteum and considerable separa- tion of the fragment. Some deformity may therefore remain under the best manage- ment, and with or without impairment of motion and power in the limb. The danger of such results will, of course, be much in- creased by any negligence on the part of the patient in seconding the efforts of the surgeon. Treatment.—In the management of this fracture, to MB language of Sir A. Cooper, the head of the os humeri is the splint which is employed to keep the acromion in its natural situa- tion. This distinguished surgeon advises the elbow to be main- tained at a little distance from the thorax, by means of a cushion placed between it and the side, at the same time that it is carried a little backward and pressed upward by a roller-bandage. In this manner the deltoid is somewhat relaxed, and the head of the hu- merus keeps the fragment properly elevated. He objects, I think very properly, to the axillary pad recommended by some. I would prefer the sling bandage I am in the habit of using in frac- tures of the clavicle. (See Southern Med. and Surg. Jour., for 1852, p. 69.) This consists of a triangular bit of shirting, with three or four yards of three inch roller-bandage sewed on to each of the acute angles of the cloth. The elbow being placed in the position above indicated, with a cushion between it and the side, in these cases is then, by means of the sling carried under it, pressed up- wards with the force requisite to restore the fragment of the acromion to its proper place; and the limb is secured in this position by car- rying the ends of the sling above and below the opposite shoulder, and the rollers around the thorax, including the fore-arm. A strip of adhesive plaster carried over the acromion is suggest- ed by Dr. Brinton (Erichsen's Surgery, p. 207) as calculated to assist in retaining the fragments in apposition. A mould might be made with softened paste-board, or strips of linen coated with starch, to cover the deltoid muscle, and thus to furnish a medium of resistance to the upward pressure of the humerus, which would effectually prevent any displacement of the fracture by the means used to keep up the shoulder. Malgaigne, who seems to give the preference to an ordinary- sling with a roller-bandage to fix the limb against the chest, adds: