5. The several phenomena that attend a fracture of the clavicle, taken
together, leave in general but little doubt as to its existence,
particularly when the fracture is oblique. As is the case in most other
instances of the kind, so here, an acute pain is felt at the instant of
the stroke; sometimes a cracking of the bone is distinctly heard by the
person injured; on every occasion, it becomes suddenly impracticable to
perform circular or rotatory motions with the arm; motions from before
backwards can still be executed, but are difficult and painful, and, as
I have already observed (1), the individual injured is reduced to the
class of animals destitute of clavicles.
Oftentimes the shoulder of the injured side, being more or less
depressed, loses its level with the other. It is also evidently drawn
forward and inward. The distance between the acromion and sternum, on
the affected side, is found on comparison, to be evidently less than on
the opposite side. In almost every case, that portion of the fractured
bone, which adheres to the sternum, forms a visible protuberance above
and on the inside of the shoulder.
6. In the mean time the pain continues. The painful drawing or dragging
occasioned by the weight of the arm forces the patient, for the purpose
of relieving it, to bend his body towards the side affected, and
incline his head in the same direction. This forms a peculiar attitude,
which of itself was frequently sufficient to disclose to Desault the
nature of the disease. We have oftentimes witnessed him establishing
the truth of this diagnostic, by merely looking at patients entering
the amphitheatre, who had been brought thither for the reduction of
such fractures.
By this position, the pains are generally relieved, because the arm
finds some degree of support; but should the patient wish to change his
position, or perform any particular motions, the pains return almost as
acutely as at first.
7. If to these signs, which are almost all of them founded in reason,
we add those that are still more palpable to the senses, such as the
mobility of the two broken ends of the bone; the crepitation produced
by their friction against each other; the depression felt at the point
of fracture, by passing the fingers over the upper surface of the bone;
and the facility of restoring to it its natural form and direction,
by moving the shoulder upwards, outwards, and backwards; it will be
difficult to be mistaken respecting the nature of this fracture. This
is perhaps more particularly the case, when the fracture is oblique, as
this kind offers the most striking diagnosis, and cannot be involved
in uncertainty, unless when a considerable swelling occurs in the
parts around the fracture. But, even then, as the circumspection
of the practitioner will necessarily direct his attention to this
circumstance, the obscurity of the signs will have no unfavourable
influence on the cure.
8. When the fracture is transverse, there is sometimes more difficulty
attending the diagnosis. The corresponding inequalities of the divided
surfaces may mutually penetrate each other and interlock, and thus
prevent a displacement. Does any uncertainty on this score exist?
Placing your fingers on the two extremities of the bone, order an
assistant to move the arm in every direction, and the motions will
be communicated to the clavicle; but, if a fracture exist, they will
be most perceptible in the fragment adjoining the shoulder, and will
separate it from that attached to the sternum. This method will seldom
deceive us, is easily employed, and subjects the patient to but a
momentary pain.
§ IV.