Chap, xix.] DISLOCATIONS OF THE HIP. 459 



limb is mainly due to the stretching of the ilio- 

 psoas muscle. 



In the thyroid luxation the extremity is said to be 

 lengthened. This lengthening is, however, apparent, 

 and is due to the tilting down of the pelvis on the 

 injured side. In the pubic dislocation there is 

 shortening, the head being carried above the ace 

 tabular level. 



. Of the modes of reducing these dislocations by 

 manipulation little can be said here. The more 

 usual proceedings may be briefly summarised as 

 follows : 



First. Flex the thigh in the adducted 

 position in luxations Nos. 1 



and 2. 

 Flex the thigh in the abducted 



To relax the 

 Y ligament. 



position in luxations Nos. 3 

 and 4. 



Secondly. Circumduct out in^ To bring back the head 



Nos. 1 and 2. (to the rent in the cap- 



Circumduct in in f sule by the same route 



Nos. 3 and 4. ) that it has escaped. 

 Thirdly. Extend in all cases. To induce the head 



to again enter the acetabulum. 

 In reducing dislocations of the hip it may be noted 

 that the internal condyle of the femur faces in nearly 

 the same direction as the head of the bone. 



In amputation at the hip-joint by long 

 anterior and short posterior flaps the following parts 

 are divided. In the face of the anterior flap will be 

 seen sections of the tensor vaginae femoris, rectus, part 

 of the vasti, the adductors longus and brevis, and the 

 gracilis. Close to the acetabulum in front are sections 

 of the ilio-psoas and pectineus muscles, and behind 

 and to the inner side the obturator extemus. In 

 this flap also, close to the angle between it and the 

 posterior flap, are small portions of the slutei to the 



