54 SURGERY. 



The reduction is managed in different ways. The ordinary plan 

 is to place the patient on the bed, and then to place a spherical pad 

 in the axilla. The surgeon makes counter-extension with his foot 

 upon the pad, and extension with his hands. If this force is not 

 sufficient, counter-extension may be made by passing a folded towel 

 or sheet under the axilla, and securing the ends iq the bed-post ; 

 and extension by fastening a folded sheet or long towel to the wrist 

 or elbow by a damp roller; thus several assistants can make exten- 

 sion at once. If this force is not sufficient, pulleys may be employed, 

 taking care that the extension be made very gradually. 



The elbow has this advantage over the wrist, as a point of appli- 

 cation of the extending band, — the elbow can be bent, and thus a 

 greater rotatory movement of the head of the bone produced. The 

 wrist is preferred by some, on account of there being no muscles 

 compressed, whose contraction might interfere with the reduction. 



After reduction, which is recognised by cessation of pain, rotun- 

 dity of the shoulder, and mobility of the limb, the arm should be kept 

 in a sling, and not used for several days. Should paralysis of the 

 deltoid continue, it may be relieved by stimulating lotions, blisters, 

 moxas, &c. 



DISLOCATIONS AT THE ELBOW. 



When both radius and ulna are dislocated at the elbow, the fore- 

 arm is bent nearly at a right angle, and is immovable. The olecra- 

 non forms a prominence behind, and the articular extremity of the 

 humerus, covered by the brachial is anticus muscle, forms a pro- 

 tuberance in front. The coronoid process of the ulna is received 



Fig. 12. 



into the greater sigmoid cavity of the humerus, and tends to main- 

 tain the bones in their unnatural situation. A lateral dislocation 

 inwards may also occur, jji which there is a great projection of the 

 external condyle of the humerus, in addition to the symptoms of the 

 first variety. 



When the ulna alone is dislocated backwards, the olecranon forms 

 a marked projection posteriorly, the elbow is bent at right angles, 

 and the forearm is pronated. 



