The nomenclature of scapulo-humeral dislocations / by Joseph Bell.

  • Bell, Joseph, 1837-1911.
Date:
1863
Catalogue details

Licence: Public Domain Mark

Credit: The nomenclature of scapulo-humeral dislocations / by Joseph Bell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    2. Dislocation forwards. 4. Intracoracoid, the most common of all. 5. Subclavicular, rare. 3. Dislocations backwards. (3. Subacromial, rare. 7. Subspinous, very rare. 4. Dislocations upwards. 8. Supracoracoid (Malgaigne knows only two cases). The classification proposed by Mr Flower, in his contribution to the most recent English system of surgery, is upon the same plan as that of Malgaigne, but modified in the direction of brevity and simplicity. It is as follows:— 1. Subcoracoid; forwards and slightly downwards; common. Onto the neck of the scapula in front of the glenoid fossa, and immediately below the coracoid process. 2. Subglenoid; downwards and forwards ; rare. Head of the humerus in front of the inferior costa of the scapula, below the glenoid fossa. 3. Subclavicular; very rare. To the inner side of the coracoid process under the clavicle. 4. Supracoracoid; upwards and forwards; very rare. On to the fractured coracoid process. 5. Subspinous; backwards; very rare. On to the back of the neck of the scapula, beneath the spine or posterior edge of the acromion. Now, there are several points in these anatomical classifications which deserve notice, and perhaps reprobation. 1. The introduction of the very rare and practically useless variety u supracoracoid ” upon very slight grounds. Malgaigne had seen one case only, and that a very doubtful one, as it was two and a half months after the accident when he first saw it. Two cases have been put on record in this country by Messrs Holmes and Prescott Hewitt, but in both the injury was complicated with fracture. In fact, it is almost impossible to conceive of such an injury without a fracture along with it, and thus such injuries ought rather to be classed under the head of dislocations with fracture, than of dislocations at the shoulder-joint properly so called. 2. The distinction between the subcoracoid and intracoracoid, which Malgaigne has made and Flower has omitted, is founded upon such minute differences, and so many cases are found intermediate, and cannot be classified under either, that it is practically useless, and, as I hope to show, it is even in a scientific point of view un- necessary. In the table at the end of this paper, I have endeavoured to arrange, 1. The typical standard surgical division; 2. Mal- gaigne’s; 3. Flower’s modification of Malgaigne’s, in such a manner as to show at a glance their mutual relations, and have ventured on adding another system of nomenclature _ based, like Malgaigne’s, on anatomical relations of position, but which I cannot help thinking both simpler and more anatomically accurate.