laterally and backwards. A
pad is inserted in the axilla, the elbow raised, and the arm placed by
the side on a pillow and steadied with sand-bags. Massage is applied
daily. As this position must be maintained uninterruptedly for two or
three weeks, it proves too irksome for most patients. When both
clavicles are fractured, however, it is, short of operation, the only
available method of treatment.

In ordinary cases the arm should be placed in that position which
gives the best alignment of the fragments and least deformity. A thin
layer of wool is placed in the axilla to separate the skin surfaces. A
sling, supporting the _elbow_, is now applied, maintaining the arm in
position, and a body bandage fixes the arm to the side. Massage and
movement should be commenced at once.

A simple method, which yields satisfactory results, is that suggested
by Wharton Hood. The fracture having been reduced, three strips of
adhesive plaster, each an inch and a half wide, are applied from a
point immediately above the nipple to a point 2 inches below the angle
of the scapula (Fig. 15). The middle strap covers the seat of
fracture, and is applied first: the others, slightly overlapping it,
extend about half an inch on either side. The elbow is supported in a
sling. This plan has the advantage that it permits of movement of the
shoulder being carried out from the first, but the plaster rather
interferes with massage.

_The Handkerchief Method._--In cases of emergency, one of the best
methods applicable to all fractures of the clavicle is to brace back
the shoulders by means of two padded handkerchiefs, folded _en
cravate_, placed well over the tips of the shoulders and tied, or
interlaced, between the scapulae. The forearm is then supported by a
third handkerchief applied as a sling, the base of which is placed
under the elbow, the ends passing over the sound shoulder.

_Operative treatment_ may be called for in compound or comminuted
fractures when the fragments have injured, or are likely to injure,
the subclavian vessels or the cords of the brachial plexus, or when it
is otherwise impossible to reduce the fracture or to retain the
fragments in apposition. It is also indicated in some cases of
fracture of both clavicles.

These various methods of treatment are not equally applicable to all
cases. In our experience, in the circumstances indicated, the
following methods have proved the most satisfactory: (1) As a
temporary means