pulation; and the coracoid process
is found to move with the arm and not with the scapula. By these
tests, and by the X-rays, this injury is distinguished from a
dislocation.

A partial fracture carrying away the lower part of the _glenoid
cavity_ simulates a sub-glenoid dislocation. This is, however, a rare
injury.

The _treatment_ consists in bracing back the shoulders and supporting
the elbow, and this is most satisfactorily done by a body bandage and
sling for the elbow, as for fracture of the middle third of the
clavicle. Passive movements and massage are employed from the first.

#Fracture of the acromion process# may result from a blow or fall on
the shoulder. It is often overlooked on account of the swelling
resulting from bruising of the soft parts, and the absence of marked
displacement. On palpation, crepitus and an irregularity at the seat
of fracture may sometimes be detected. The shoulder is slightly
flattened, and abduction of the arm is difficult. In rare cases the
fracture passes into the acromio-clavicular joint, and is associated
with dislocation of the clavicle.

In connection with this fracture, reference must be made to a
condition frequently met with, in which the epiphysial portion
of the acromion is found to be separate from the body of the
process--_separate acromion_. This is by some (Symington, Hamilton)
looked upon as a want of union of the epiphysis, but the weight of
evidence seems to prove that it is rather of the nature of an
un-united fracture at this level, even when, as sometimes happens, it
is bilateral (Struthers, Arbuthnot Lane).

Between the fourteenth and twenty-second years a true _separation of
the epiphysis_ may be met with, but it is seldom possible to make a
positive diagnosis of this injury. As is the case in all fractures of
the acromion, bony union seldom takes place.

The _treatment_ is the same as for fracture of the lateral end of the
clavicle.

#Fracture of the coracoid process# is rare. It may result from direct
violence, such as the recoil of a gun, but it is more often an
accompaniment of dislocation of the shoulder or of the lateral end of
the clavicle upward. As the coraco-clavicular ligaments usually remain
intact, there is no displacement; but when these are torn the coracoid
is dragged downwards and laterally by the combined action of the
pectoralis minor, biceps, and coraco-brachialis muscles. Crepitus may
be elicited on moving the fragment. _Separa