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
Catalogue details

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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    The muscular masses between which the body of the scapula lies will usually prevent much displacement of the fragments, unless the inferior angle of the bone be alone separated, in which case the displacement is sometimes very marked. There are, how- ever, some cases cited by Malgaigne and by Lonsdale in which the displacement of the fragments was very remarkable. In these cases the fractures were below the spine and in the long diameter of the bone, so that the action of the Teres major may have caused the displacement of the lower fragment. But this state of things may also be attributable to the combined influence of a laceration of the muscular layers and of the inefficiency of the retentive means subsequently used in the treatment. In the treatment of these fractures, attention should be directed to the injury of the soft parts, as well as to the solution of osseous continuity. There may be a laceration of the skin alone, or of this and the muscles, down to the bone, thus constituting a com- pound fracture; or the contusion may have affected the tissues so seriously as to be followed by suppurative inflammation. If there be a compound fracture the wound should be carefully explored, and any detached fragment of bone immediately removed. The edges of the wound should then be approximated by means of adhesive plaster, taking care, in bad cases, to place a small tent in the wound for the escape of any pus that may be formed. In short, this should be treated upon the general principles applica- ble to other compound fractures. If the laceration does not expose the bone, the case will be managed as other lacerated wounds: by adhesive plasters and cold water dressings. In cases attended with mere contusion, the application of cold water, or of evapora- ting lotions, will usually suffice to abate the tendency to inflam- mation. Leeching may sometimes become necessary. Should suppuration ensue, an exit should be made for the pus as early as possible, in order to prevent its diffusion between the muscles. At the same time that treatment is being thus directed to the soft parts, measures should be taken to maintain the fragments in their proper position and to prevent any motion between them. Many plans, more or less complicated, have been devised for this purpose. The simplest will, however, be found to be the most comfortable to the patient, and probably as effectual as any other. I would therefore, with many of the best authorities, advise a