A NEW BANDAGE FOR FIXATION 
OF THE 
HUMERUS AND SHOULDER-GIRDLE. 
CHARLES W. DULLES, M.D., 
FELLOW OF THE COLLEGE OF PHYSICIANS AND OF THE ACADEMY OF SURGERY 
OF PHILADELPHIA; SURGEON TO THE OUTPATIENT DEPARTMENTS OF 
THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA, AND OF 
THE PRESBYTERIAN HOSPITAL, IN PHILADELPHIA. 
BY 
FROM 
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LEA BROTHERS CO., PHILADELPHIA. A NEW BANDAGE FOR FIXATION OF THE 
HUMERUS AND SHOULDER-GIRDLE. 
In the treatment of injuries about the shoulder- 
joint, such as luxation, contusion, fracture of the 
clavicle, or of the acromial end of the scapula, etc., 
I have often felt the need of some form of bandage, 
which, while as efficient as the Velpeau or Desault 
bandage, should be less cumbrous; and I have been 
led to try various modifications of these until I hit 
upon a way of bandaging which has been so satis- 
factory to me and to my patients that I wish to bring 
it to the notice of my professional brethren, and to 
obtain their judgment upon its merits. 
This form of bandage requires, for an adult, a 
roller about three and a half inches wide, and 
about ten or twelve yards long. It is applied as 
follows: 
The arm of the injured side should be placed 
against the chest-wall, almost in the perpendicular 
line, but with the elbow a little in advance, and the 
forearm flexed at a right angle and laid across the 
lower part of the chest. 
A large piece of lint, or a soft towel, or a piece of 
old muslin, should now be interposed between the 
arm and the body, going well up into the axilla, 4 
so as to prevent the excoriation which usually results 
from the apposition of two skin surfaces. 
Then the surgeon, standing behind the patient, 
and a little toward the injured side, should apply the 
initial end of the roller to the axilla of the sound 
side, and carry the bandage diagonally across the 
back to the top of the shoulder of the injured side ; 
then straight down the front of the arm to the point 
of the elbow ; then under this to the back of the arm; 
then up behind the arm to the shoulder, where the 
preceding turn crossed it At this point a firm 
pull should be made on the bandage, to draw the hu- 
merus well up against the glenoid cavity. In cases 
of fracture of the clavicle or scapula, this piece can 
easily be regulated so as, with the aid of a little 
manipulation, to place and keep the ends of the bone 
in position. Then the bandage is to be carried 
diagonally across the front of the chest to the axilla 
of the sound side; then through this axilla to the 
back ; then horizontally across the back to the lower 
third of the arm of the injured side, and round this 
to the front of the arm; then across the front of the 
chest to the axilla of the sound side, leaving the 
forearm out; then through this axilla to the back near 
the point of starting. The appearance of the band- 
age when one complete circuit has been made is 
shown (back and front views) in Figures i and 2. 
The bandage is completed by repetition of these 
turns till the roller is used up, advancing with each 
turn a little way up on the shoulder, and a little way 
up on the arm. If one roller does not suffice to give 
the support desired, of course a second must be 
added (Fig. 3). 5 
After the bandage is in place a few large pins 
should be inserted at each crossing, and the hand and 
Fig. i. 
Back view. 
Fig. 2. 
Front view. 
forearm should be supported by a sling. In addition 
to the pins, the bandage may be stitched so as to 6 
make a firm case; or a few strips of adhesive plaster 
maybe applied along and across it in different places, 
which will give the greatest possible security. It is 
Fig. 3. 
Front view. 
a good plan to attach a strip of adhesive plaster, an 
inch and a half wide, from just below the shoulder, 
over the outer side of the arm and round the point 
of the elbow, to about the middle of the forearm. 
This will prevent the bandage from slipping off the 
elbow. 
In certain cases it is advisable to include the fore- 
arm in the bandage, so as to bind it firmly to the 
chest-wall. But one of the special advantages of this 
method, in my opinion, depends upon the fact that 
it can usually be employed without including the 
forearm. 
This form of bandage accomplishes the following 
results: It fixes the scapula and the outer end of the 7 
clavicle, holds the head of the humerus well up against 
the glenoid cavity, and fixes the whole bone against 
its natural splint, the chest wall. Among its advantages 
the most important, in my opinion depends upon the 
exactness with which, by drawing up the humerus in 
the line of its axis, the bone and the shoulder-girdle 
can be held in a position in which there is the least 
muscular interference with the proper position of the 
fragments in a fracture of the scapula or clavicle, or 
of the different bones in a luxation at the shoulder- 
joint. I find that, with a little manipulation with 
my free hand, and careful regulation of the upward 
pull upon the humerus and the downward pressure 
upon the scapula or clavicle, by means of the bandage 
as it goes along, I can get all that I can ask for in 
the way of correct anatomical relation of parts. The 
position of the humerus, which I have indicated, is 
also, I believe, a better one than that which is main- 
tained by the bandage most frequently employed—I 
mean the Velpeau bandage. 
The comparative lightness of this dressing is also 
an advantage, as well as the fact that it leaves the 
upper and lower ends of the arm uncovered, so that 
they may be examined at any time, or have applica- 
tions made to them. The freedom of the forearm I 
have already alluded to as an advantage whenever it 
is admissible. 
There is no danger of the bandage slipping, if it 
be snugly and firmly applied, and if it be wide 
enough. It is easy to make it fit nicely at the elbow, 
so as to hold this in a sort of cup made by the slight 
elasticity of the material. 
It is also easy, by varying the position of the turns, 8 
to make the bandage cover any particular point in 
the scapula, or in the outer end of the clavicle, or in 
the humerus. In fractures of the clavicle, or scapula, 
a suitable compress may be placed over the seat of 
fracture ; while, in any fracture of the humerus, to 
which such a dressing is suitable, the arm may be 
splinted against the chest-wall by carrying the hori- 
zontal turns high up. 
I will not attempt to speak of the conditions to 
which this form of bandage is applicable, but I think 
they are all those in which fixation of the arm and 
shoulder-girdle is the important object. 
I am aware that it is somewhat dangerous to call 
anything new in these days, but I have so designated 
the bandage I have just described, because I have 
not met with any description which corresponds to 
it. If I am mistaken, I shall be happy to be cor- 
rected. 
3932 Locust Street, Philadelphia.