TRYE ON THE INJURIES TO WHICH THE LOWER LIMBS ARE EXPOSED. 
775 
Art, XLV. Llustrations of some of the Injuries to which the lower Limbs are exposed. 
By Cuartes Brannon Trre, Member of the late Corporation of Surgeons in London, 
of the Royal Medical Society in Edinburgh, of the Medical Society in London, and Surgeon 
of the Gloucester Infirmary. 4to. pp. 37. 
OBSERVATIONS of this kind made 
from cases actually occurring are always 
valuable. he author has had the op- 
portunity of examining, in two instances, 
after death, the state of parts deranged 
by violent, but not of itself fatal, exter- 
nal injury: the one a dislocation of the 
femur, the other a fracture of the neck 
of the upper articulating head of the 
same bone, without complete dislocation. 
These cases are the basis of the present 
short publication, and have furnished 
seven plates of the appearances after dis- 
section. 
It is well known to surgeons that, of 
these two accidents, dislocation without 
fracture, though generally caused by ter- 
rible violence, producing immediate de- 
formity, and requiring often excessive 
exertion to be reduced, is less formidable 
than a fracture of the neck of the femur; 
which last is incurable, no instance being 
well authenticated, we believe, ofa perfect 
cure of this calamitous injury. The diag- 
nosis of the two is therefore important, 
but sometimes difficult, especially in stout, 
corpulent, and muscular subjects. 
In the present case, the dislocation was 
upwards and outwards; and on account 
of the other injuries, which soon proved 
mortal, no reduction was attempted. 
In two other cases which occurred to 
the author, the attempts at reduction 
were successful; and the following re- 
marks upon this operation may interest 
our readers. 
«< The taxis or reduction of the dislocated 
thigh bone is often a difficult operation. I 
know of no mode which invariably promises 
success. Much must be left to the inge- 
nuity of the suszeon, who will vary the pos- 
ture of the patient, and the application of his 
own effort, to reduce the bone, as his judg- 
ment shall direct him in the instance before 
him. 
«« One principle, however, I think may be 
laid down, viz. to fix the pelvis firmly when- 
ever extension of the limb is to be made. In 
a strong muscular man, whose thigh had 
been dislocated upwards and outwards, after 
fruitlessly trying other methods, the follow- 
ing process succeeded. He was laid prone 
upon a bed; a sheet was passed between his 
thigh, and held firmiy by two assistants. [ 
then knelt upon the pelvis, in order to 
keep it steady, and resistits being raised up 
when the extension should be made. Three 
men then pulled at a towel, fastened round 
the thigh above the knee, and drew it in such 
a direction as to carry the thigh upwards; 
that is,.in relation to the trunk, backwards. 
I then rested my two hands on the head of 
the bone, and pushed it dowawards and for- 
wards with all my strength; and after a short 
exertion of our powers in this manner, I di- 
rected a gentleman who held the leg to twist 
the toes suddenly outwards, upon which the 
head rushed into the acetabulum with a loud 
noise. 
‘¢T tried the same, and a variety of other 
methods, in a very muscular middle-aged 
woman, unsuccessfully, within six hours 
after her accident. She took half a drachm 
of Dover's powders at bed-time the succeeding 
night, and the next morning used the warm 
bath, and was well sweated for two hours be- 
fore the intended time of repeating the taxis, 
She was laid upon a bed, on the sound side. I 
then pressed my left hand against the head of 
the bone, one of my knees against its body, a 
little higher than the middle, and with the 
ather hand I drew her knee outwards. The 
leg was supported by an assistant, the knee 
bent foanght angle. Three persons made 
steady the pelvis by holding a sheet passed be- 
tween the thighs, and three others made the 
extension. In this manner our strength was 
exerted for some time, and I plainly felt the 
head of the bone move, but the reduction 
was not completed. We renewed our at- 
tempts in the same manner, except that a 
gentleman, who became one of the extenders, 
placed his foot firmly against the arch of the 
pubis (properly defended) and thereby both 
increased his power of extension, and, at the 
same time, rendered the pelvis more steady 
and fixed. The force being continued for 
some time, ‘and my hands and knee being 
applied in the manner already described, 1 
directed the assistant, who supported the 
bent leg, suddenly to carry the internal ancle 
towards the other leg, and to twist the toes 
outwards, and then the head slipped into the 
acetabulum. The day on which the accident 
took place there was uncommon rigidity and 
hardness of the muscles; but after the opera- 
tion of the sudorific and the bath, the tension. 
and resistance were greatly diminished.” 
A good case is added of compound 
luxation of the tarsus, in which, as the 
bones could not be returned, and there 
was no alternative but amputation, or 
removing the protruded bone ; the latter 
was adopted, and the astragalus was en- 
tirely taken out. 
The patient recovered, and was able 
to walk, in six months, with the assist- 
ance, however, of a stick, a jointed iron 
from the hip, and a high shoe. The 
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