of retention in emergency cases,--for example,
accidents occurring on the football field,--the handkerchief method.
(2) In uncomplicated fractures of average severity in any part of the
bone, the method of sling and body bandage. (3) In cases where, for
aesthetic reasons, the chief consideration is the avoidance of
deformity and the maintenance of the symmetry of the shoulders, as in
girls, the treatment by recumbency. (4) When retentive apparatus
fails, or when the fragments are exerting injurious pressure,
operative treatment.

[Illustration: FIG. 15.--Adhesive Plaster applied for Fracture of
Clavicle.]

In quite a number of cases, there is an excessive amount of pain,
preventing sleep; where this is due to cramp-like contractions of the
muscles and movements of the fragments, it is relieved by more
accurate fixation, as by strips of plaster; otherwise a hypodermic
injection of heroin or morphin is indicated.

DISLOCATION OF THE CLAVICLE

Dislocation of the #acromial end#--sometimes, and perhaps more
correctly, spoken of as dislocation of the scapula--is more frequent
than that at the sternal end, and it usually results from a blow from
behind, or from a fall on the tip of the shoulder, driving down the
scapula, so that the clavicle projects _upwards_ and overrides the
acromion process.

_Downward_ displacement of the acromial end of the clavicle is much
rarer, and may follow a fall on the elbow or a blow over the clavicle.
The end of the bone lies under the acromion process, in contact with
the capsule of the shoulder-joint, and the acromion stands out
prominently.

The _clinical features_ are so well marked that the diagnosis is
unmistakable. The head inclines towards the affected side, and the tip
of the shoulder tends to pass slightly downward, forward, and
medially. The displaced end of the bone can be seen and felt as a
prominence under the skin, or the empty socket can be palpated, while
the muscles attached to the displaced clavicle stand out in relief.
The movements at the shoulder are restricted, particularly in the
direction of abduction above the level of the shoulder. These injuries
are sometimes associated with fracture of the ribs, a complication
which adds materially to the difficulties of treatment.

_Treatment._--Reduction is easily effected by bracing back the
shoulders and replacing the bone in its socket by manipulation; but
retention is invariably difficult, and in many cases impossib