Volltext: The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri (4)

been formed for the reception of the enlarged 
heads of the humeri behind the glenoid cavi¬ 
ties, and partly beneath the bases of the spines 
of the scapulae just where the head of the 
humerus has been found to rest in the ordi¬ 
nary dislocation backwards from accident ; 
but in this case, although the history was 
unknown, that these appearances were not 
the result of accident is almost certain, 
as similar abnormal appearances are ob¬ 
servable on each side. The notice of this 
preparation in the catalogue of the museum 
is as follows (p. 108—3*2.) : — “ The bones of 
both the shoulder joints of an adult. In each 
joint there has been ‘ ulceration,’ or such 
absorption as occurs in chronic rheumatism 
of the articular surface of the head of the 
humerus, and the glenoid cavity. The heads 
of the humeri are flattened and enlarged by 
growths of bone around their borders; and the 
glenoid cavities, enlarged in a corresponding 
degree, and deepened, extend backwards 
and inwards to the bases of the spines of the 
scapulae. The articular surfaces, thus en¬ 
larged, are mutually adapted, and are har¬ 
dened, perforated, and in some parts polished 
and ivory-like. The changes of structure 
are symmetrical, except in that the articular 
surfaces of the right shoulder joint are more 
extensively polished than those of the left.” 
Section II. — Accident. — The principal 
accidents the shoulder joint and the bones in 
its immediate vicinity are liable to, are frac¬ 
tures and luxations. 
Fractures.—A fracture may traverse the 
acromion, the coracoid process, or detach 
the glenoid articular portion of the scapula 
from the body of this bone by passing directly 
across the neck of the scapula. 
A. Fracture of the acromion process. — A 
fracture of the acromion process may be caused 
by the fall of a heavy body on the superior 
surface of the acromion ; but this accident 
most usually occurs in consequence of falls 
in which the patient is thrown from a height 
on the point of the shoulder. The fracture 
of the acromion will be generally found to 
have taken place at a point behind, and within, 
the junction of the clavicle with this bony 
process ; its direction we always observe to 
be in the original line of the junction of the 
epiphysis with the rest of the bone. In this 
accident, if the distance be measured from 
the sternal end of the clavicle to the extre¬ 
mity of the shoulder, it will be found lessened 
on the injured side. Considerable ecchymosis 
of the shoulder may be expected soon to suc¬ 
ceed the injury, and the patient will be unable 
to elevate the arm. Sometimes the perios¬ 
teum of the acromion is not torn, and then, 
although the fracture of the bone has been 
complete, there is no displacement of the 
fragments. If, however, this fibrous invest¬ 
ment of the acromion, above and below, be 
completely torn across, the acromion process 
will be found to be depressed, because it will 
be pulled down by the weight of the extremity 
and contraction of the deltoid muscle. The 
portion of the acromion thus detached is 
generally very moveable, following the clavicle 
whenever the arm is moved. This accident 
is best recognised by the surgeon first taking 
hold of the elbow of the affected side, and 
elevating the whole arm perpendicularly. 
“ Having thus restored the figure of the part, 
he places his hand upon the acromion, and 
rotates the arm, when a crepitus can be dis¬ 
tinctly perceived at the point of the spine of 
the scapula.” * 
Fractures of the acromion unite by bone, 
sometimes with much deformity, arising from 
ossifie depositions, which however do not, 
after a time, interfere much with the motions 
of the arm. This union has sometimes been 
known to take place in forty-eight days, and 
in other cases in a much shorter time. The 
union, however, is frequently only ligamentous. 
Sir A. Cooper speaks of a false joint being 
occasionally the result of a fracture. Mal¬ 
gaigne, alluding to a case in which a false 
joint was the consequence of a fracture of 
the acromion, says that the fractured surfaces 
presented a polished appearance, and were 
covered with an ivory deposit, the effects of 
friction. He adds, that the union was not 
simply a ligamentous connexion, but that an 
arthrodial false joint had been formed. In 
all the specimens of this fracture examined by 
Malgaigne, the superior border of the fracture 
was surmounted with small bony crests of 
new formation, of which the more consider¬ 
able number grew from the scapular portion 
of the acromion, while those produced from 
the detached extremity of this process were 
but few, no doubt in consequence of its lesser 
degree of vitality. This remark of Malgaigne 
coincides with the observations to be found 
in Sir Astley Cooper’s Work, that the dis¬ 
position to ossifie union is very weak in the 
detached acromion. Malgaigne, however, re¬ 
fers to a preparation in the Museum of Du¬ 
puytren, in which the external fragment pos¬ 
sessed a thickness almost double that of the 
portion of bone from which it had been de¬ 
tached. This thickness the writer of the 
Catalogue of the Museum thought was caused 
by an overlapping of the fragments of the 
broken portions ofthe acromion ; but Malgaigne 
supposes it to have arisen from simple hyper¬ 
trophy of the detached fragments. 
B. Fracture of the coracoid process — is a 
rare accident, and when it does occur, it is 
generally the result of a severe injury, in 
which the fracture of the bone is the least of 
the evils attendant on the compound injury. 
ThusBoyerf gives us the account of a fracture 
of the coracoid process produced by the blow 
of a carriage pole ; the patient died in a few 
days afterwards, in consequence of the severe 
contusion he suffered at the moment of the 
accident. The coracoid process, when frac¬ 
tured at its basis, is pulled downwards and 
forwards by the lesser pectoral coraco-bra- 
chialis and short portion of the biceps muscle. 
We are told}; that if the contusion accom¬ 
panying this accident be slight, we can seize 
* Sir A. Cooper. 
f Maladies Chirurgicales. | Sanson.


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