5 12 



APPLIED ANATOMY. 



To detect this accident Allis advises that while an assistant pushes upward on the 

 knee in the direction of the long axis of the femur, the surgeon by flexing and 

 extending the knee will find the nerve alternately made tense and relaxed in the 

 popliteal space. 



Signs of Luxation. When luxated posteriorly the foot is inverted whether it 

 is a low or high dorsal. The thigh is adducted, bringing the knee of the affected side 

 in front of the sound one. The thigh is usually slightly flexed. There is shortening, 

 and the higher the position of the head the greater the shortening and the farther up 

 the trochanter is above the Roser-Nelaton line. Shortening is best seen with the 

 Lhighs flexed to a right angle (Fig. 517). 



When luxated anteriorly the foot is everted or almost straight. If it is a low 

 thyroid there will be little or no eversion; if it is a pubic luxation eversion will be more 



marked. The thigh is abducted; this is 

 more marked in the thyroid and less in 

 the pubic. The thigh is flexed in the 

 thyroid but may be straight in the pubic. 

 There is no shortening but there may be 

 a slight lengthening difficult to demon- 

 strate (Fig. 518). 



Reduction. As in the shoulder 

 there are two methods of reducing a 

 dislocated hip, the direct and the indi- 

 rect. The direct consists in placing the 

 head in as favorable a position as possi- 

 ble and then directly pushing or pulling 

 it towards the socket. 



The indirect consists in using the 

 thigh as a lever and rotating the head 

 into place. These methods may be used 

 in combination. 



Direct Method for Dorsal Luxa- 

 tions. Patient flat on the floor on his 

 back. Flex the knee on the thigh, and 

 the thigh on the abdomen; this brings 

 the head down from a high position to 

 a low one below the acetabulum. Ad- 

 duct the thigh slightly; this relaxes the 

 Y ligament and prevents the head catch- 

 ing on the rim of the acetabulum. 



Grasp the ankle with one hand, 

 then place the other hand or arm beneath 

 the bent knee and lift upward and inward 

 thus raising the head over the rim of the 

 acetabulum into the socket. If the head 

 does not enter rotate the thigh gently, 

 first out and then in, lifting at the same time. This rotation is to open the rent in 

 the capsule to its widest extent. Too much rotation narrows the rent and obstructs 

 the entrance of the head. An assistant may at the same time endeavor with his 

 hands to push the head up towards the socket. 



Another way of using the direct method (Stimson) is to place the patient 

 face downward on a table with the thigh flexed at a right angle hanging over its 

 end. The leg is then flexed at the knee and pressure made directly downward, 

 gently moving or rotating the head from side to side. This is a safe and efficient 

 method. 



Direct Method for Anterior Luxations. In pubic luxations first slightly abduct 

 the thigh and rotate the shaft of the femur inward so as to transform the pubic to a 

 thyroid luxation. For thyroid luxations flex the knee to a right angle, and then 

 flex the thigh on the abdomen to a right angle or even more and slightly abduct 

 (Allis) . Then with one hand grasp the ankle and with the other hand or arm in the 



FIG. 518. Thyroid luxation on the anterior plane. 

 The thigh is flexed and abducted; the toes pointing; 

 forward. (From a photograph by Dr. Chas. F. Nassau.) 



