Clinical notes : upon two years surgical work in the Liverpool Royal Infirmary / by W. Mitchell Banks.

  • Banks, William Mitchell.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Clinical notes : upon two years surgical work in the Liverpool Royal Infirmary / by W. Mitchell Banks. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    instance, blie fracture must have been the one described by Sir Astlrv Cooper, which, commencing above at the supra-scapular- notch, cuts off the coronoid process, glenoid cavity and anatomical aeck from the blade, leaving the acromion and spine intact. In making this diagnosis the two chief reasons were (1.) that when the whole scapula and glenoid were fixed, the humerus moved freely in the glenoid area and no crepitus was audible, and (2.) that w hen the blade of the scapula alone was fixed and the shoulder moved up and down, crepitus was immediately and always pro- duced. In Hamilton's Fractures the signs of this accident are given; notably a falling down of the humerus and attendant frag- ment of the scapula, which is readily done away with by support, but recurs as soon as the support is taken away. But it is admitted that, if the coraco-acromial and coraco-clavicular liga- ments are not ruptured, very little displacement of the fragments ma)' occur. Such was very likely to have been the case here, looking at the manner in which the accident occurred. For it is not difficult to conceive that, the old woman having been knocked flat on her face, the wheel of the cart, as it mounted over her shoulder and back, may have so pressed upon the upper part of the humerus and neck of the scapula, as to break the latter off from the rest of the bone, and yet leave the various ligaments attached to the coracoid process uninjured. If this view is correct, the injury was a very rare one, and being the only fracture of the scapula that has as yet come under my observation, more than ordinary pains were taken with the examination. The arm was suspended in a sling and kept bandaged to the side and in a few days the patient left the Infirmary and attended the out-door department. When last seen, about seven weeks after the accident, she could move the shoulder without pain, but pressure about the neck of the scapula still hurt her. Ununited Fracture of iheSumerus—Two Resections.—The patient was a very powerful, ruddy, healthy looking collier, thirty-two years of age. Ten months before admission he fell and sustained a simple fracture of the right humerus in the middle third. A mere fibrous union resulted and the ami was practically useless. Under antiseptics the ends of the fractured bone were sawed off and the Eragments retained in position by a large leather splint which fixed the shoulder and elbow. Twelve days afterwards the wound was