9. We do not generally find fractures of the clavicle accompanied by
such accidents as the anatomical relations of the parts might lead us
to apprehend. The external force being all expended in fracturing the
bone, extends but feebly to the brachial plexus, which would be much
injured by the shock, were the bone to yield, without breaking, to the
action of external bodies striking against it. Hence, without doubt,
would arise serious affections, as may be fairly inferred from the
analogy of blows on the head and vertebral column, and as is indeed
confirmed by certain cases reported by Desault.
CASE I. Two bricklayers were brought to the Hotel-Dieu, who had met
with similar accidents. A piece of timber, thrown from a building,
in which they were engaged, had struck them, the one on the external
part of the left clavicle, the other about the middle of the right. A
considerable wound pointed out in each the place on which the blow had
been received. But the former, having escaped a fracture, experienced
nothing but an acute pain, while the second had the bone broken in two
places.
The customary apparatus was applied to the latter, and the treatment
which we shall presently describe, being pursued, the result was that
complete success which never failed to crown the attentions of Desault.
In the other patient a considerable swelling made its appearance the
day after the accident. On the third day a numbness and partial loss
of the power of motion occurred in the arm of the affected side. Soon
afterwards an insensibility came on, and by the seventh day, the
paralysis of the arm was complete. It was not till after a tedious
treatment, an account of which would be foreign from my present
subject, that the limb recovered in part its original strength.
From whatever cause the fracture of the clavicle in this latter patient
was prevented, it is evident, that the whole of the force employed to
produce the fracture in the other, acted here on the brachial plexus,
and gave rise, by means of concussion, to the accidents which followed.
10. The axillary artery, though running near to the clavicle, in common
with the brachial nerves, experiences, notwithstanding, less frequently
than they do, injurious effects from the fracture of this bone. I
know not of any instance where a puncture from the broken ends of the
clavicle has produced in this artery a false aneurism. To conclude,
like all other fractures, that of which we are now treating, may be
connected with wounds, splinters, &c. But in general, as Hippocrates
remarks, the fracture of the clavicle assumes in common cases a mild
aspect.
§ V.