DISLOCATIONS AT THE ELBOW. 55 



Reduction of the above forms of dislocation is efTected by making 

 forcible extension of the forearm over the surgeon's knee, which is to 

 be placed at the elbow, to make counter-extension. The forearm is 

 to be bent while extension is produced. 



The radius is dislocated at its upper extremity, either forwards or 

 backwards. Backwards is the most frequent displacement. The 

 head of the bone forms a prominence behind, the arm is bent and 

 the hand is prone. When displaced anteriorly, there is a distinct 

 prominence in front, the arm is slightly bent, but cannot be com- 

 pletely flexed, and there is some pronation. 



The reduction is effected by making forcible extension and pro- 

 nation at the same time, if the displacement be anteriorly ; if the 

 displacement be posteriorly, supination is to be produced with exten- 

 sion. In both the head of the bone is to be pressed upon by the 

 surgeon's thumb, in order to facilitate its sliding into its proper 

 place. 



Dislocation at the elbow occurs but rarely, on account of the 

 ginglymoid character of the joint, and is generally accompanied 

 by considerable laceration of the soft parts. Rest, cold applications, 

 a sling, are subsequently required and together with general anti- 

 phlogistic means. 



It is produced, most frequently, by force applied to the wrist, 

 and when complicated with fracture of any of the processes, anchy- 

 losis, gangrene, and other dangerous results may follow, especially if 

 the reduction is delayed, and adhesions have formed. 



DISLOCATIONS AT THE WRIST. 



The radius and ulna may be separated from the carpus, either 

 anteriorly or posteriorly. When ^{s\ocdi\.eA forivards there is a great 

 projection in front, and the hand is bent backwards ; when back- 

 wards, the projection is behind, and the hand is flexed. 



It is produced by violent bending of the hand, and is accompanied 

 by rupture of the ligaments and stretching of the tendons. The 

 reduction is easily effected by extension and pressure. Pain, swell- 

 ing, and stiffness of the joint may follow, which are to be obviated by 

 cold applications, rest, lotions, &c. ; if there should be a tendency to 

 its reproduction, a light splint may be applied. 



If the radius alone is dislocated from the carpus, which is gene- 

 rally anteriorly, the hand will be somewhat twisted, the radial side 

 ol* it being thrown backward. The ulna may be dislocated back- 

 wards upon the radius, rupturing the sacciform ligament, and pro- 

 ducing a projection on the back of the wrist, by which it is easily 

 recognised. It is readily reduced by pressure and extension. A 

 splint and bandage may be necessary to prevent its recurrence. 



DISLOCATION OF THE BONES OF THE HAND. 



Displacement of the bones of the carpus rarely occurs. Occa- 



