10. A fracture of the neck of the humerus assumes, in general, a
character not very troublesome; and if, as Heister says, “a fracture
near the head is worse, and more difficult to be cured,” this is less
owing to the nature and seat of the disease, than to the difficulty of
keeping the fragments in contact.
Seldom have the reunion of the bone, and the removal of all the
disagreeable effects accompanying the accident, required a longer
time than is necessary for the cure of other fractures. The numerous
examples, which occurred in the Hotel-Dieu, during Desault’s direction
of the surgical department, confirm the truth of this assertion,
notwithstanding some doubts that may have been raised respecting it,
by prejudices formerly entertained, on the subject of fractures in the
vicinity of joints.
From twenty-six to thirty days are sufficient for the reunion: this was
the term commonly required in the Hotel-Dieu.
11. If judiciously managed, art readily removes all the accidents
attendant on this fracture; but, if otherwise, the consequences are apt
to prove troublesome. It is here, much more particularly than in other
places, that all deformity of the part ought to be prevented; because,
the neck of the humerus being near to the centre of the motions of the
arm, will very essentially impede those motions if it be not properly
reunited. A deformed callus has been known to produce, in the hollow of
the arm-pit, a protuberance, which has, in part, prevented abduction,
and appeared to keep up an habitual swelling in the limb.
It is, then, from the perfection of the apparatus, and not from the
vicinity of the injury to a joint, that the prognosis is to be formed,
both as to the consequences, and as to the duration of the fracture.
Keep the fragments in exact and regular contact, and there will be no
obstacle to that success which seldom forsook Desault.
§ V.