Part 14
When a fractured clavicle is fairly broken across it is more easily
treated, but when broken obliquely it is more difficult to manage.
Matters are different in these cases from what one would have supposed;
for a bone fairly broken across can be more easily restored to its
natural state, and with proper care the upper part may be brought
down by means of suitable position and proper bandaging, and even
if not properly set, the projecting part of the bone is not very sharp.
But in oblique fractures the case is similar to that of bones which
have been torn away, as formerly described; for they do not admit
of being
[p. 222] restored to their place, and the prominence of the bone is
very sharp. For the most part, then, it should be known, no harm results
to the shoulder or to the rest of the body from fracture of the clavicle,
unless it sphacelate, and this rarely happens. A deformity, however,
may arise from fracture of the clavicle, and in these cases it is
very great at first, but by and by it becomes less. A fractured clavicle,
like all other spongy bones, gets speedily united; for all such bones
form callus in a short time. When, then, a fracture has recently taken
place, the patients attach much importance to it, as supposing the
mischief greater than it really is, and the physicians bestow great
pains in order that it may be properly bandaged; but in a little time
the patients, having no pain, nor finding any impediment to their
walking or eating, become negligent; and the physicians finding they
cannot make the parts look well, take themselves off, and are not
sorry at the neglect of the patients, and in the meantime the callus
is quickly formed.
1 The method of dressing which is most appropriate,
is similar to that used in ordinary cases, consisting of cerate, compresses,
and bandages; and it should be most especially known in this operation,
that most compresses should be placed on the projecting bone, and
that the greatest pressure should be made there. There are certain
physicians who make a show of superior skill by binding a heavy piece
of lead on the part in order to depress the projecting bone; but this
mode of treatment does not apply to the clavicle, for it is impossible
to depress the projecting part to any extent worth mentioning. There
are others who, knowing the fact that the bandages are apt to slip
off, and that they do not keep the projecting parts in their place,
apply compresses and bandages like the others, and then having girt
the patient with a girdle, where it is usually applied with most effect,
they make a heap of the compresses upon the
projecting bone when they apply them, and having fastened the head
of the bandage to the girdle in front, they apply it so as to bring
the turns of it into the line of the clavicle, carrying them to the
back, and then bringing them around the girdle they
[p. 223]carry them to
the fore part and again backward. There are others who do not apply
the bandage round the girdle, but carry the rounds of it by the perineum
and anus, and along the spine, so as to compress the fracture. To
an inexperienced person these methods will appear not far from natural,
but when tied, they will be found of no service; for they do not remain
firm any length of time, even if the patient keep his bed, although
in this position they answer best; and yet even when lying in bed,
should he bend his leg, or should his trunk be bent, all the will
be displaced; and, moreover, the bandaging is inconvenient, in as
much as the anus is comprehended by it, and many turns of the bandage
are crowded there in a narrow space. And in the method with the girdle,
the girdle cannot be so firmly girt around, but that the turns of
the bandage force the girdle to ascend, and hence of necessity all
the other bandages must be slackened. He would seem to me to come
nearest his purpose, although after all he effects but little, who
would take a few turns round the girdle,
but would use the bandage principally to secure the former bandaging;
for in this manner the bandages would be most secure, and would mutually
assist one another. Every thing now almost has been said which applies
to fracture of the clavicle. But this also should be known, that in
fractures of the clavicle, it is the part attached to the breast which
is uppermost, and that the piece attached to the acromion is the lowermost.
The cause of this is, that for the most part the breast can neither
be depressed nor raised, there being but a slight movement of the
joint at the breast, for the sternum is connected together on both
sides with the spine. The clavicle admits of most motion at the joint
of the shoulder, and this arises from its connection with the acromion.
And, moreover, when broken, the part which is connected with the sternum
flies upward, and is not easily forced downward; for it is naturally
light, and there is more room for it above than below. But the shoulder,
the arm, and the parts connected with them, are easily moved from
the sides and breast, and, on that account, they admit of being considerably
elevated and depressed. When, therefore, the clavicle is broken, the
fragment attached to the shoulder inclines downward, for it inclines
much more readily
[p. 224]with the shoulder and arm downward than upward.
Matters being as I have stated, they act imprudently who think to
depress the projecting end of the bone. But it is clear that the under
part ought to be brought to the upper, for the former is the movable
part, and that which has been displaced from its natural position.
It is obvious, therefore, that there is no other way of applying force
to it (for the bandages no more force it to than they force it from);
but if one will push the arm when at the sides as much as possible
upward, so that the shoulder may appear as sharp as possible, it is
clear that in this way it will be adjusted to the fragment of the
bone connected with the breast from which it was torn. If one then
will apply a bandage,
secundum artem, for the purpose of promoting
a speedy cure, and will reckon everything else of no value, except
the position as described, he will form a correct opinion of the case,
and will effect a cure in the speediest and most appropriate manner.
It is of great importance, however, that the patient should lie in
a recumbent posture. Fourteen days will be sufficient if he keep quiet,
and twenty at most.