ennett). A main fissure usually
runs transversely across the infra-spinous fossa, and secondary cracks
radiate from it (Fig. 26). In other cases the line of the primary
fracture is longitudinal, passing through the spine and involving both
fossae.

[Illustration: FIG. 26.--Transverse Fracture of Scapula, with fissures
radiating into spinous process and dorsum.]

The _clinical features_ are obscured by swelling of the overlying soft
parts. Crepitus may sometimes be elicited by placing one hand firmly
over the bone, and with the other moving the arm and shoulder. When
the spine is implicated, the fragments may be grasped and made to move
one upon another. The displacement, which usually consists in
overlapping of the fragments--although sometimes they are drawn
apart--is partly due to the action of the serratus anterior and teres
major muscles, and partly depends on the direction of the force.
Movement is restricted and painful. Osseous union usually takes place
rapidly, and although displacement often persists, the function of the
limb is unimpaired.

_Treatment._--As these fractures are usually complicated by other
injuries, especially of the thorax, and are accompanied by severe
shock, it is necessary to confine the patient to bed. It is usually
sufficient to fix the arm and shoulder to the chest wall by a firm
binder, in the position which admits of the most complete apposition
of fragments. This retentive apparatus is employed for about three
weeks, after which the patient is allowed to use his arm. The bandages
are removed daily to admit of massage.

#Fracture of the surgical neck of the scapula#, although a rare
accident, is of importance, as it is liable to be mistaken for
dislocation of the shoulder. The line of fracture runs through the
scapular notch, downwards and laterally to the lower margin of the
glenoid, so that the glenoid and the coracoid process are separated
from the rest of the bone.

The coraco-acromial and coraco-clavicular ligaments are usually torn,
and the detached fragment, along with the head of the humerus, sinks
into the axilla, causing a flattening of the shoulder, and leaving a
depression below the projecting acromion. These signs may be obscured
by the general swelling of the shoulder. The arm may be lengthened
about an inch. By supporting the arm the deformity is at once reduced,
but recurs as soon as the support is withdrawn. Crepitus is usually
detected on carrying out this mani