CONTENTS. XVII. Excision of the Clavicle, . XVIII. Diseases and Excisions of the Shoulder, XIX. Diseases and Injuries of the Elbow-joint, XX. Diseases and Excisions of the Wrist-joint, XXI. Dislocations and Fractures of the Scapula, EXCISION OF THE CLAVICLE. BY E. C. FRANKLIN, M.D., St. Louis, Mo. Excision of the clavicle on account of necrosis, or for malignant. growths, may be regarded as an established operation of recent date. Mr. Davie, of Bungay, first excised the inner extremity of the clavicle in a case of dislocation backwards from deformity of the spine, the luxated head pressing upon the oesophagus to such an extent as to endanger life by inanition. Prof. Gross, of Philadelphia, in 1849, removed the clavicle. from a lad of thirteen years of age, on account of necrosis. Dr. Charles McCreary, of Hartford, Ky., removed the right clavicle from its articulations, in a boy fourteen years of age, for caries; the patient lived many years, with excellent use of the corresponding limb. Dr. A. J. Wedderburn, of New Orleans, and also Prof. Blackman, of Cincinnati, have each removed this bone with good results. The greatest operation of the kind, however, was performed by Prof. Mott, in 1828, on account of an osteo-sarcoma of great size and hardness, the tumor being conical in shape, and four inches in diameter at its base. The operation required four hours for its performance, and was one of extreme delicacy and difficulty, requiring forty ligatures to control the hemorrhage. The patient made a good recovery, and by the aid of a mechanical apparatus had good use of his arm, having the ability to move it in any direction. Dr. C. R. S. Curtis, of Chicago, in 1856, removed the entire clavicle, on account of osteo-sarcoma, in a woman twenty years of age. The growth returned at the cicatricial surface in about two months after the resection. Dr. E. S. Cooper, of California, also performed a very formidable operation for osteo-sarcoma, with successful results. Although its removal is rarely required in gunshot wounds of the clavicle, in very extensive comminutions the complete resection of the bone may possibly be expedient. It was resorted to twice during the war of the rebellion, but on both occasions with a fatal result. The first case is accredited to a Confederate surgeon, name not given, at the battle of Spottsylvania. Dr. James C. Palmer, now Surgeon-General, United States Navy, also performed excision of this bone, the wound having been caused by a fragment of shell, which splintered the bone throughout its entire length. The patient survived the operation about two weeks. O. P. Hayfelder has collected nine cases of complete removal of the clavicle, six of which resulted favorably. Other successful operations have been reported, but I have not been able to find a detailed account of them. Edwin Partial excisions of this bone are more common. Powell, of the Seventy-second Illinois Volunteers, performed a partial resection of the outer third of the right clavicle, the patient dying a few days afterwards. Surgeon Hayes, United States Volunteers, reports a case wherein the sternal third of the bone was fractured by a conoidal ball. When admitted into the hospital, the denuded clavicle protruding, it was excised, but death resulted a few days subsequently from pyæmia. Surgeon I. A. Sidell, United States Volunteers, reports a case of comminuted fracture of the middle third of the left clavicle. The broken ends of the bone overlapped each other, were denuded of periosteum, and bathed in pus. Fears were entertained that by some unlucky movement of the elbow the artery lying beneath might be injured. It was determined to remove about two inches of the middle third with a chain-saw and osteotome, great caution being exercised that the artery received no injury, but in two weeks afterwards this case also terminated unfavorably. Dr. Gurdon Buck reports a favorable case of removal by the chain-saw of the outer portion of the clavicle as far as the attachments of the sterno-cleido-mastoid muscle. The integuments above and below were then dissected up and held in apposition. by iron wire sutures. Portions of sequestered bone were removed subsequently, during the healing process, from time to time, and the case finally resulted in recovery-"with no power in the arm, and the wound not fairly closed." Acting Assistant Surgeon J. A. Hall excised two and one-half inches of the middle third of the clavicle, through an incision three inches long. The patient made a good recovery, and was discharged from the service with "disability total, but temporary." Acting Assistant Surgeon A. S. Green removed the acromial half of the bone at the articulation, through a straight incision, and the case terminated favorably. The pension agent reports the patient's disability total and permanent. Assistant Surgeon P. S. Connor, United States Army, reports an interesting case where the fractured ends of the clavicle. were rounded off and the loose fragments of bone removed, in consequence of a gunshot injury, the missile comminuting the clavicle and neck of the scapula. Death resulted a few days afterwards. Assistant Surgeon R. L. Johnson, P. A. C. S., reports a case wherein the sternal third of the right clavicle was fractured and comminuted for the space of about two inches, and the sternal end split to within one-half inch of the articulation. There being an open suppurating wound, the clavicle was disarticulated and removed, together with all spicule of bone. The patient survived the operation only a month. Acting Assistant Surgeon J. R. Merrett removed a sequestrum of the right clavicle, three-fourths of an inch in length, in consequence of a comminuted fracture by a minié ball. The case resulted favorably. I removed nearly one-half of the left clavicle, in consequence of a gunshot injury. The patient, George W. Spalding, of Company D, Fifty-second Regiment of Illinois Volunteers, aged twenty-three years, was wounded at the battle of Pittsburg Landing, Tennessee, on the sixth day of April, 1862. A round |