Remarks upon fractures of the scapula, with cases presenting striking peculiarities : read before the Medical Society of the State of Georgia, at their annual meeting in Augusta, April 8, 1857 / by L.A. Dugas.

  • Dugas, L. A. (Louis Alexander), 1806-1884.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: Remarks upon fractures of the scapula, with cases presenting striking peculiarities : read before the Medical Society of the State of Georgia, at their annual meeting in Augusta, April 8, 1857 / by L.A. Dugas. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    The body of the scapula may be fractured by violence directed against the back of the thorax, such as blows with a club or other heavy missiles, the kick of a horse, &0. 1 saw an accident of this kind resulting from the fall of a portion of the plastering in the ceiling of a high-pitched apartment. The person was seated, and was probably leaning forward when the heavy mass fell upon the scapula. In another instance that came under my observation, the body of the scapula was fractured by the hoof of a horse; in running over the man. In such eases the true nature of the injury is considerably masked by the violence done to the soft parts, which are necessarily very much contused, sometimes considera- bly ccchvmosed, and soon become the seat of tumefaction and great soreness. The patient will soon find all attempts to use the arm attended with pain over the whole of the scapular region, and the careless observer might easily overlook the deep-seated injury. But if the surgeon will place the fingers of one hand upon the inferior angle of the bone so as to fix it against the thorax, while he seizes the shoulder with the other hand and imparts motion in various directions to the humeral portion of the scapula, crepitation may be detected more or less distinctly. This may sometimes be facilitated by elevating the humerus at the same time. In the first case to which I just referred as having come under my observation, the patient would herself occasionally feel the crepitation on endeavoring to carry the elbow upwards or back- wards, and would compare the sensation to that which might be occasioned by one edge of the bone slipping over the other. Un- der such circumstances, the hand of the surgeon applied flatly upon the scapula, would enable him to perceive the crepitus. By causing the patient to fold his arms across his breast, the scapula becomes more prominent, its general shape may be better defined, and the surgeon may, by measuring its diameters, establish a com- parison with that of the uninjured side. Malgaigne (Tom. 1, p. 502) advises the forearm to be flexed and the hand to be carried forcibly back of the thorax, for the purpose of rendering the scapu- la more prominent, and consequently thus to facilitate its inspec- tion. It must be confessed, however, that although the judicious surgeon will rarely fail to detect the existence of a fracture of the body of the scapula, it is always difficult and often impossible for him to determine the precise locality, shape, and extent of the injury.