290 TREATMENT OF DISLOCATIONS, 



limb. I have frequently been consulted on these cases, all of 

 which have originated in the neglect of a proper attention to the 

 fracture at first. 



. The treatment here must be one of two kinds : we may either 

 open the skin opposite the fracture, and, laying bare the bone, re- 

 move the soft portion interposed with a fine saw, treating the case 

 afterwards as a compound fracture ; or we may insert a seton ex- 

 actly through the soft cartilaginous portion, and keep it open ten 

 days or a fortnight. After this time the seton should be removed, 

 the wound closed, and the part treated as a simple fracture. 

 Either of these plans will usually prove successful, and firmly con- 

 solidate the limb : but, when there is no lapping over of the ends 

 of the bones, the latter is the most mild and convenient, and 

 equally certain of success. 



TREATMENT OF DISLOCATIONS. 



The joints most liable to this injury are the shoulder and knee 

 'before, and the stifle and hip behind. The first step is to examine 

 whether there be a fracture also, which is frequently the case. 

 Under these circumstances the treatment is rendered more com- 

 plex, from the difficulty of reducing the dislocation, without using 

 too much violence to the limb. The mode of detecting this addi- 

 tional evil is not difficult : for if fracture is present, there will be 

 an evident roughness and grating of the bones, which will be sen- 

 sibly felt by the hand. 



When it is attempted to reduce a simple dislocation, it is evident 

 that the direction in which the dislocated bone is parted from its 

 socket should be first taken into consideration in the means used 

 for reducing it. A moderately firm extension should then be 

 made by two persons ; one holding the body and one part of the 

 joint, and the other supporting the immediate dislocated limb, at 

 the same time giving the luxated end a direction towards its socket. 

 If this extension is sufficiently and properly made, the dislocated 

 bone will slip into its place, and render the limb perfect. When 



