8 



THE TONER LECTURES. 



sity in the rotation of the limb, are additional reasons in favor 

 of the distension theory of its pathology. Flexion and adduc- 

 tion, Dr. Sayre has shown to be the position of the limb which 

 produces the greatest capacity of the capsular ligament of the 

 hip, and we ought to see this position, therefore, as a rule in 

 distension-luxations. But I only find two cases in which there 

 were adduction and flexion. In the other cases the position is 

 not stated, except in one in which the limb was extended. 



As to treatment, reduction is generally easy when the lux- 

 ation is discovered early, but if the discovery or treatment be 

 tardy it is always difficult and often impossible. In 11 cases 

 reduction was successfully accomplished seven times by mani- 

 pulation, twice by extension, and twice by both means. In 8 

 cases reduction was not effected, and in 8 the result is not 

 stated. Only two cases of recurrence of the luxation are noted, 

 a rather surprising fact in view of the relaxation of the distended 

 tissues ; but its possibility should be borne in mind and guarded 

 against hy the same prophylactic means that I will name 

 directly. No snap is heard on reduction, all tension and suction- 

 power of the joint being lost. Even after reduction the leg may 

 be somewhat longer than the other, owing, probably, to the 

 distension, to the swollen articular gland, and possibly in old 

 cases to interstitial changes in the neck of the femur. 



The question of prophylaxis is perhaps the most important 

 of all, and the indications are clear. First, a careful watching 

 and repeated examination of the hip-joint, especially in children, 

 to detect any effusion. If any exist, the position of the leg 

 becomes of the greatest possible importance. As adduction and 

 internal rotation favor spontaneous dislocation, the leg should 

 be kept in abduction and external rotation. The first indication 

 is easily fulfilled by two lateral sandbags which may be bridged 

 across in front at intervals by a bandage, to keep the leg at rest 

 between them, or by lateral splints. The foot may be kept in 

 external rotation by bandages or adhesive plaster fastened to 



