gment passes upwards and
medially.

[Illustration: FIG. 28.--Impacted Fracture of Neck of Humerus, in man
aet. 75.

(Sir H. J. Stiles' case. Radiogram by Dr. Edmund Price.)]

Although there is sometimes overlapping and broadening after union,
beyond some limitation of the range of abduction the usefulness of the
limb is seldom impaired.

_Treatment._--Massage, by allaying spasm of the muscles, soon
overcomes the moderate amount of displacement which is usually met
with. Further, the skin surfaces of the axilla having been separated
by a thin layer of cotton wool, a sling is applied to support the
wrist, and the arm is bound to the side by a body bandage.

In comminuted fractures and those with marked displacement, a general
anaesthetic may be required to ensure accurate reduction; and to
maintain the fragments in apposition, and to avoid any limitation of
abduction after union, the limb may be fixed in the position of
abduction at a right angle by means of a Thomas' arm splint with
swivel ring, and extension applied, if necessary, to maintain this
attitude. After a week or ten days the patient is allowed up, wearing
an abduction frame (Fig. 29), or a splint, such as Middeldorpf's,
which consists of a double inclined plane, the base of which is fixed
to the patient's side, while the injured arm rests on the other two
sides of the triangle. Massage and movement are employed daily.

[Illustration: FIG. 29.--Ambulatory Abduction Splint for Fracture of
Humerus.]

Should these measures fail, the fracture may be exposed by an incision
carried along the anterior border of the deltoid, and the ends
mechanically fixed, after which the limb is put up in the abducted
position for three or four weeks. Massage is commenced on the second
or third day. Union is usually complete in about four weeks.

#Separation of Epiphysis.#--The upper epiphysis of the humerus
includes the head, both tuberosities, and the upper fourth of the
inter-tubercular groove. On its under aspect is a cup-like depression
into which the central pyramidal-shaped portion of the diaphysis fits.
This epiphysis unites about the twenty-first year.

[Illustration: FIG. 30.--Radiogram of Separation of Upper Epiphysis of
Humerus.]

Traumatic separation is met with chiefly between the fifth and
fifteenth years, and is most common in boys. It usually results from
forcible traction of the arm upwards and away from the side, as in
lifting a child by the upper ar