Fracture of the scafiula. - If the acromion be broken, it is easily reduced with the fingers, if the os humeri is raised a little upwards; but it is with such difficulty retained, that the arm can seldom be afterwards lifted freely: after the reduction, a compress must be put on it, and a ball under the arm pit: after the bandage is applied, the arm must be supported by a sling.

If the neck of the scapula, which is below the acromion, or the acetabulum, be broken, the accident is not easily discovered; but a stiffness of the joint, inflammation, abscess, or other bad symptoms, follow.

All other fractures of this bone are less hazardous; and to reduce them, an assistant should extend the arm forward, whilst the surgeon is employed in restoring the fragments with his hands, laying on it compresses, with pasteboard splints, and securing all with the fascia stellata, or quadriga. See Bell's Surgery, vol. vi. p. 76; White's Surgery, p. 140.

A fractured sternum. - After a depression or a fracture, the part is in pain; and the accident is known by the bone grating, if moved by the fingers, and by its moving in consequence of a little pressure against it; though the proper indication is a manifest sinus or inequality in the part.

From the irritation produced by the fracture, and in part by the violence which occasioned it, pains in the breast, difficulty of breathing, violent cough, haemoptoe, extravasations of blood within the mediastinum, with other dangerous symptoms, follow. To reduce it, the patient must lie on his back over some hard pillows, that his shoulders may be depressed, and the breast elevated; the operator must then press forcibly, to extend the ribs, and push the sternum forward. If this fails, a crucial incision must be made into the skin, and the depressed part of the sternum elevated with a terebra, gently screwed into the part.

After the reduction, the napkin and scapulary may be applied, to keep the thorax firm.

Mr. Bell, in the sixth volume of his Surgery, page 67, observed, that in some cases it is fractured without being displaced; in others it is not only broken, but it the same time forced in upon the pleura. When, therefore, the pain, cough, oppressed breathing, and other symptoms, do not yield to blood letting and other parts of an antiphlogistic course, an incision should be made upon the injured part, of a sufficient length to admit of a free examination of the bone; and the depressed piece may be raised either with a common scalpel, or a levator, if there be an opening that will admit an instrument. When this is not practicable, an opening may be made for this purpose with the trepan. If the operation be performed with caution, the bone may be raised with safety; and the sore must then be treated in the usual way. See White's Surgery, p. 139.

Fractures of the -vertebrae . - When any of the vertebrae are fractured without affecting the spinal marrow, the posterior apophyses, or acute tubercles, are only injured, and these fractures are not dangerous. The parts may be replaced with the fingers, and on each side of the spina dorsi narrow compresses moistened with spirit of wine should be applied, secured with pasteboard splints, the napkin, and scapulary.

Fractures in these parts are easily known by the pain, and on slightly touching them.

If the transverse apophyses which tend towards the cavity of the thorax are broken, the heads of the ribs inserted into them will likewise be fractured, and the case is dangerous.

When the body of a vertebra is broken, the spinal marrow is injured, and the parts below the fracture are motionless, and death soon follows. In this .case, not to seem either negligent or ignorant, the injured part must be laid bare, the fragments which press the medulla elevated, and, if loose, extracted: the wound may then be cleaned and dressed with warm stimulating applications. See Boerhaave's Aphorisms; Petit on the Diseases of the Bones; Aitkin's Treatise on Frac4 S 2 tures; Pott's General Remarks on Fractures; and Kirk-land's Observations on Pott's Remarks; for machines to be used after the reduction of fractures, see Gooch's Cases and Remarks; Bell's Surgery, vol. vi. p. 71; White's Surgery, p. 142.