DISLOCATIONS OF THE INNER END OF THE CLAVICLE.—The clavicle may be dis located forward, backward, or upward, in this order of frequency.
Forward dislocation may be complete or incomplete. The head of the bone is prominent and may be displaced inward. The shoulder sinks downward and in ward. The arm is useless. There is local pain. This dislocation is usually caused by a forcible depression and pushing backward of the shoulder, by which the centre of the clavicle comes to rest on the first rib, and on it as a fulcrum the inner end is pried upward and forward. By pulling the shoulder upward and backward and pressing on the dislocated bone reduction is affected; but reten tion is often difficult. Dorsal decubitus with a figure-of-8 bandage about the two shoulders, the turns crossing in the back, may prove effective or may be reinforced by direct pressure by a molded plaster-of Paris splint, a hernial truss, or a pad re tained in position by adhesive plaster, or a figure-of-8 bandage, crossing in front. If all precautions fail and the dislocation becomes habitual, two or three biweekly injections of alcohol with immobiliza tion may be attempted, or the capsule exposed and shortened.
I3ackward dislocations may be either complete or incomplete. The head of the bone passes backward and may compress any of the important structures at the root of the neck. This dislocation may be caused by direct violence or by forc ing the shoulder forward and inward. Reduction is effected and maintained by drawing the shoulder backward and out ward and retaining it in that position.
-Upward dislocation is caused by de pression of the shoulder. The head of the bone rests on the episternal notch, having passed behind the sternal head of the sterno-mastoid. Reduction is made by drawing the shoulder upward and out ward and pressing the head of the bone down. Here, again, retention is diffi cult, and Malgaigne's patellar hooks have been suggested as an adjunct to the treatment.