72 
of dislocation of the knee, to which we refer 
for many observations we have not space for, 
gives a case of luxation of the femur backwards 
and of the tibia forward, which in some re- 
spects differed from those adverted to by Sir 
A. Coo He informs us that M. Lavalette 
was called. on the 6th of April, 1815, to visit a 
man who had just before met with the accident 
we are now describing under the denomination 
of dislocation of the femur backwards and of 
the tibia forwards at the knee-jomt. The limb 
was in a state of extension, somewhat inverted, 
and much shortened; it could, however, be 
flexed and extended, although with much pain. 
The extensor muscles of the leg were in a 
relaxed condition, as were also the hamstring 
muscles from the shortening of the whole limb, 
A depression existed where the condyles of the 
femur ought to present themselves anteriorly, 
and below this space the superior extremity of 
the condyles of the tibia could be felt. e 
patella was placed horizontally on the upper 
articular surface of these condyles; its point, 
which is normally placed downwards, was now 
directed forwards, and its superior margin back- 
wards; its anterior or cutaneous surface was 
placed directly upwards, and its articular facet 
downwards, resting, as already mentioned, on 
the flat surface of the upper extremity of the 
condyles of the tibia. Tactic here knew 
that he had to deal with a complete luxation, 
which we have called a luxation of the femur 
backwards and of the tibia forwards; and he 
was finally convinced of the real nature of the 
case by placing his hand in the popliteal re- 
gion, where he distinctly felt the two condyles 
of the femur. 
Luxation of the lower extremity of the 
Jemur jorward.—The lower extremity of the 
femur is sometimes thrown forwards off the 
condyles of the tibia, while the latter bone is 
thrown backwards behind the condyles of the 
femur, producing the following appearances: 
the limb is shortened, the condyles of the os 
femoris are seen projecting, the ligament of the 
patella is depressed, and the leg is bent for- 
wards. Sir A. Cooper gives a case in which 
the condyles of the femur were completely dis- 
located forwards, and the head of the tibia 
passed so far backwards behind the condyles 
as to fill up completely the popliteal space. 
The tendinous connexion of the patella to the 
rectus muscle was ruptured ; the external con- 
dyle of the os femoris was very protuberant; 
the leg was bent forward and shortened, and a 
depression existed just above the patella. The 
patient felt most excruciating pain when the 
limb was moved, but when at rest theré was 
not any considerable suffering; the luxation 
was reduced, and in five months recovery was 
complete. 
Lateral luxation of the femur at the knee- 
joint.—Although from the structure of the parts 
it might at first be supposed that complete la- 
teral luxation should be less resisted than the 
luxation of the femur either forwards or back- 
wards, still there is no case on record with 
which we are acquainted of complete lateral 
luxation of the femur from the tibia as the 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
result of accident. We commonly see 
one of the condyles of the femur abandon 
tibia, while the-other remains in the ca 
first had left. The luxation is then wh 
called incomplete. The reduction of this It 
ation is easy in consequence of the rupt 
the ligaments.* 
Dislocation outwards of the femur ai 
knee-joint.—In the dislocation ou 
femur at the knee-joint, this bone is thr 
off the external condyle of the tibia, 
latter bone projects on the inner side of 
joint so as at once to disclose the nature 0 
injury. Sir A. Cooper once saw a case of 
kind at St. Thomas's Hospital, and 
was struck with three circumstances. The f 
was the great deformity of the knee from 
projection of the tibia inwards; the seco 
the ease with which the bone was reduce 
gradual extension ; and the third, the * 
tlammation which followed upon what 4 
So serious an injury. The man was di peas 
after a few weeks, having suffered little loca 
constitutional irritation. 
Example of dislocation of the mur 
wards.—Mr. Bovill was thrown from a 
the femur projected much externally ee tl 
knee, and the tibia much (below the situati 
of the inner condyle of the femur) to the i 
side of the condyle of the os femoris. © 
limb was extended from the thigh-bone, 
bent position ; the extension was a long ti 
continued, and force was employed by: 
persons for half an hour re the 
was reduced. Sir A. Cooper saw him ei 
months after the accident; the 
not then bend the limb at right angles witht 
thigh ; there was also an unnatural lateral m 
tion of the joint from the injury which 
ligaments had sustained. ola 
Incomplete dislocation of the femur i 
at the knee-joint—The femur is sometim 
thrown on the inner side of the knee-joint, ¢ 
condyles of the tibia being carried outwar 
The under surface of the inner condyle o 
femur may be felt through the skin, while 
outer condyle of this bone rests on the ¢ 
cavity hollowed on the u per casa 
inner condyle of the tibia, or rather b 
A deformity is produced analogous to t 
the external dislocation, and may be: pal D 
ceived. From the little experience had of su u 
cases, the reduction of the limb is stated to 
equally easy with the former, and the 
recovers with little diminution of the p owe 
the part. Sir A. Cooper states as his opini 
that in these cases the condyle of the os. femc 
with respect to the tibia is thrown somew 
backwards as well as outwards or ae 
alderman fell from his horse and partial! 
located the condyle of the os fomectaie ar 
and the tibia outwards; the femur wend - 
replaced. He was perfectly recovered am \ 
months. a 
To whichever side the tibia is lu 
always pulls with it the patella, which » 
* Blandin says : “ Je 1 ‘ai eprouvé m ! a 
fois 4 ’Hépital de la Charité,” Trae 
Topog. Paris, 1826, p. 617. 
