Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29465/615/
ABNORMAL CONDITIONS OF THE SHOULDER JOINT. 
a distinct crepitus could be perceived. The 
head of the bone could be felt in the glenoid 
cavity, and when the shaft of the humerus was 
rotated no motion was communicated to the 
head. On the seventh day after the accident 
all swelling had subsided, and the appearances 
noted were as follows ; — On viewing the 
shoulder in front, a very remarkable angular 
projection of bone forwards is observed. This 
prominence is very near the anterior margin 
of the deltoid muscle, and near the centre of 
a line drawn from the scapular end of the 
clavicle to the margin of the anterior wall of 
the axilla. This projection is evidently the 
abrupt termination of the upper extremity of 
the lower fragment of the humerus ; every 
movement communicated to the shaft of the 
bone also moves this projecting point, a little 
below, and to the outside of which, an indent¬ 
ation or slight puckering of the skin is observ¬ 
able. This last we can readily suppose has 
been produced by the lower fragment having 
perforated the deltoid muscle, and engaged 
itself in the deeper layer of the integument. 
“ On viewing the joint sidewise or in pro¬ 
file, the posterior angle of the acromion pro¬ 
jects much behind, while the abrupt promi¬ 
nence already mentioned, formed by the shaft 
of the humerus, is very salient in front; so 
that in this side view, the antero-posterior 
diameter of the joint is seen to be much in¬ 
creased. The long axis of the arm is di¬ 
rected from above downwards and backwards, 
very slightly also outwards. By measurement 
from the acromion to the external condyle of 
the humerus, the injured side is found to be 
a quarter of an inch shorter than the oppo¬ 
site. The patient cannot himself perform any 
of the movements of the shoulder joint, ex¬ 
cept that of rotation to a small extent, but 
can permit the humerus to be freely moved 
by another. Although crepitus was evident 
at first, now, seven days having elapsed since 
the accident, it can no longer be elicited. 
“ May Vlth. — Nearly a month has passed 
since he received the fall ; he has regained 
considerable power of motion over the left 
arm, can even raise his hand to the top of his 
head. On the 6th of June he left the hospi¬ 
tal, being able to use his arm ; the deformity, 
consisting in the abrupt projection of bone, 
was somewhat reduced.” 
4. Fracture of the surgical neck of the hu¬ 
merus below the tuberosities and original line 
of junction of the epiphysis with the shaft of 
the tone.—In this case there is much de¬ 
formity to be observed. The head and tuber¬ 
osities form the superior fragment, which in 
general remains in its natural situation, while 
the upper extremity of the lower fragment, 
which last is constituted by the principal part 
of the shaft of the humerus, is drawn upwards 
and forwards under the pectoral muscle. 
When the arm is grasped at the elbow by the 
surgeon, and pushed upwards, the upper ex¬ 
tremity of the broken shaft of the humerus 
is made to project at the inner side of the 
coracoid process of the scapula, and is felt to 
roll whenever the arm is rotated. 
Fracture of the humerus in its surgical 
neck occurs at different heights in this bone. 
The most common situation for the fracture 
is where the spongy portion of the bone 
unites with the rest of the shaft ; and here it 
is that the humerus, considered anatomically, 
would seem to be the least capable of resist¬ 
ing external violence. The direction of the 
fracture is generally transverse, more rarely 
is it oblique, and, in this last case, the ob¬ 
liquity is generally in a line from without in¬ 
wards, and from above downwards, parallel to 
the line of the anatomical neck of the hu¬ 
merus, but below it, and the nature of the 
displacement is variable. Most frequentlv 
the inferior fragment is drawn inwards towards 
the axilla ; but the inferior fragment has been 
also observed to be displaced and become 
prominent in other directions. Desault has 
seen it thrown backwards ; Dupuytren, Pa- 
letta, Duret, and others, have seen it raised 
up, and even perforate the deltoid muscle 
outwards ; finally, it more frequently still has 
been observed to become prominent in front 
towards the coracoid process. 
Mons. Gely has, in the Journal de Chi¬ 
rurgie, mentioned a case of fracture of the 
surgical neck of the humerus, in which the 
fracture was oblique, the obliquity running 
parallel with, but below, the anatomical neck 
of the humerus. The inferior fragment had 
perforated in front the deltoid muscle, very 
near to the interstice which separates the 
deltoid from the pectoral muscle; the arm 
was shortened an inch. These observations 
refer to the altered position of the inferior 
fragment, resulting from a fracture through 
the part of the humerus called the surgical 
neck. It is said that usually the superior 
fragment remains in its normal position in 
these fractures, but this is not always the 
case. Malgaigne narrates a case of a man, 
aged 78, in whom the humerus was fractured’ 
transversely in its surgical neck, about an 
inch and a half above the folds of the axilla. 
There was an overlapping of the bones; the in¬ 
jured arm was consequently one inch and a 
half shorter than the other. The fracture 
during life could not be reduced; he died on 
the twenty-sixth day after the injury. The 
inferior fragment was drawn inwards and for¬ 
wards, and indeed during life had raised up 
the soft parts towards the union of the del¬ 
toid and pectoral muscles, more internally than 
the situation of the coracoid process; the over¬ 
lapping of the fragments was to the amount 
already mentioned. The fracture through the 
humerus was beneath the tuberosities, the 
longitudinal axis of the lower fragment was 
in the direction upwards and inwards, and 
the longitudinal axis of the upper fragment 
was directed downwards and outwards. In 
a word, the superior fragment was in a posi¬ 
tion which would correspond to the highest 
elevation of the arm in the normal state; and 
the inferior, on the contrary, was in a position 
which corresponded to its greatest depres¬ 
sion. 
Dislocations.—The head of the humerus