The regimen to be pursued during the reunion of the clavicle, varies
according to circumstances. It is impracticable to lay down general
rules, applicable to all affections of this kind. Here, however, much
more than in other cases, if the division of the bone be simple, and
no unfortunate accident occur, it is always unnecessary to restrain
the patient from his usual course of life, beyond the second or third
day. But, though internal means are for the most part omitted in the
treatment, the apparatus is a subject on which too much attention
cannot be bestowed. With whatever degree of exactness it may be at
first applied, it will soon become loose, and oppose a diminished
resistance to the weight of the shoulder, and the action of the
muscles. Hence, unless it be frequently examined, the fragments will
be displaced. The following case furnishes a detail of the treatment
subsequent to the reduction, to which, in ordinary cases, Desault had
recourse.
CASE III. Mary Adel, aged thirty, as she was crossing a path covered
with ice, in the severe winter of 1788, fell on the point of her left
shoulder, and fractured the clavicle about the middle. Being brought to
the Hotel-Dieu a few hours after the accident, she was dressed in the
manner just described, and, as the fracture was simple, it was judged
sufficient to make a slight diminution in the quantity of her aliment,
during the two or three first days. The dressing was moistened every
morning, with vegeto-mineral water, at the place corresponding to the
fracture.
On the fourth day the piece of linen that surrounded the bandage was
removed, for the purpose of examining the state of the parts. Every
thing was found in its proper situation, and the covering was replaced
till the seventh day, when the rollers appeared to be somewhat relaxed.
The apparatus was taken off, and reapplied as at first, the compresses
being carefully moistened with vegeto-mineral water, at the part lying
over the fracture. After the third day the patient was permitted to
return to her usual regimen. The third roller being a little deranged
on the tenth day, it was taken off, and reapplied as at first, together
with the sling. The fragments were examined and found in perfect
contact. The patient was up during the whole day, walked about the
house, and experienced no other inconvenience than that of not being
able to use the left arm.
On the thirteenth day, the bandage was again reapplied, and allowed to
remain till the sixteenth, when the patient having disturbed it, it
was once more changed. At this period, the fragments, already firmly
united, exhibited scarcely a vestige of the division they had sustained.
The reunion was complete by the twentieth day, when all the pieces
of apparatus were dispensed with, except the bolster and the second
roller, which were also removed two days afterwards, as they were found
to be no longer necessary.
The continued inactivity of the limb, during the treatment, had
occasioned a stiffness in the shoulder. This was gradually done away by
making the patient move her arm in all directions, twice a day, each
time, for the space of an hour.
On the twenty-ninth day she left the hospital, carrying with her
nothing to remind her of the injury she had sustained. She was free
from that uneasiness which is the consequence of a tedious and
ill-managed treatment, during which the exercise of the limb has been
neglected.
§ IX.