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Fracture of the Collar-bone.The bone is usually broken near the middle, and the fracture is in most cases oblique, so that one end rides over the other. This fracture will be detected by simply feeling along the course of the collar-bone and comparing it with the corresponding bone of the other side. There will be felt a roughness and usually a projection at one point, pressure upon which causes the patient acute pain. By manipulating the bone at this point we can usually detect a grating sensation. The patient is unable to use the arm ; the shoulder droops toward the chest. This drooping is due to the removal of the natural support of the shoulder, the collar-bone. In children, a fracture of the collar-bone presents somewhat different signs. It will be remembered that fractures of bones in children are frequently incomplete, a portion only of the bone being broken, while the remainder yields to the pressure and bends. As a result, the shoulder often retains its natural position in children who have suffered this " green stick " fracture of the collar-bone. The chief signs in these cases are extreme tenderness at some point in the bone and swelling in the vicinity of this painful spot. Treatment.-Fractures of the collar-bone are very easily set, but are kept in position with great difficulty. In fact more or less deformity is the usual result; cases in which the bone heals without any deformity are to be regarded as exceptions, and indicate good fortune rather than exceptional skill on the part of the surgeon. The difficulty lies simply in the impossibility of keeping the fragments at rest. Every movement of the arm and shoulder has a tendency to disturb the broken ends of the collar-bone. It would be out of place in this work to describe the various kinds of apparatus which have been devised and employed in the treatment of broken collar-bones. Good results have been obtained with nearly all, though none can be relied upon to prevent deformity. The chief object of the apparatus is to keep the shoulder pressed firmly backward, for in this way the broken ends of the bone are brought into their proper position. To accomplish this object, straps are applied around the arm just below the shoulder, and around the shoulder itself. These are then drawn backward and attached to straps proceeding from the other shoulder. By inserting buckles at the back between the shoulders, these straps can be tightened sc as to hold the shoulder of the injured side firmly in position. Another way is to attach broad bands of adhesive plaster around the arm and shoulder of the injured side, and to make these adhere firmly across the back and under the arm of the opposite side. The writer once secured a perfect result-that is, union of the fragments with absolutely no deformity-by fitting a plaster of Paris jacket over the shoulder and arm of the injured side. The jacket extended down onto the chest and back, and was re-enforced by muslin bandages extending around the body and over the opposite shoulder. When the dressing was removed it was almost impossible to detect any difference between the collar-bones of the two sides. This result, however, has been obtained by other dressings, and does not necessarily prove the superiority of the plaster of Paris. When the patient lies flat upon the back, the shoulder falls backward, and the fragments drop into their natural position. If, therefore, the patient can be passive enough to keep this position most all the time for a month, the best possible chance for recovery without deformity is thereby afforded. Most individuals would prefer to suffer a slight deformity rather than to endure the monotony of such a measure. It may be, however, worth the trouble if the patient is a girl. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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