SPRAINS. 505; 
To reduce an old luxation of the humerus in man, Mayor had to. 
employ twenty-one assistants! Compare the strength of the muscles-of 
man to that of the powerful masses surrounding the shoulder or the 
hip of our large species. Assistants are rarely pulling at the same 
time, the tractions are jerky ; for these reasons blocks and_-pulleys, which 
work steadily and regularly, had better be used. At first, the pull- 
ing is done in the present direction of the displaced bone, bringing it by 
degrees, as the leg is elongated, to its normal direction. During this 
step, the operator tries to obtain the coaptation; and, as soon as the 
bones are on a level, he, pushes them against each other, in the axis 
they ought to occupy normally ; ordinarily at that moment a special 
snap is heard, due to the meeting of the two articular extremities. The 
movements become possible, the joint resumes its normal aspect, the leg 
its natural length. The sudden change in the function of the extremity 
is striking. 
In studying special luxations we will see that each of them has spe: 
cial manipulations for its reduction. ‘Those are sometimes very hard 
and long; but by varying the direction of the tractions, in watching 
closely the coaptation, ordinarily the parts can be returned in their 
good -position. Some cases. occur when the attempts fail, and sub- 
cutaneous section of the fibrous strictures, or antiseptic arthrotomy has to 
be resorted to. Avoiding the blood vessels and the important nerves, the 
skin is divided, as well as the connective tissue, muscles, synovial ; the 
alterations are examined ae visu ; the effused fluids are made to escape, 
the ligaments, which prevent the articular coaptation, are divided. This 
‘operation, which gives good results in man,-has been partly successful 
in our hands on a dog suffering with an old luxation of the elbow. 
The reduction obtained, return of the luxation must be prevented. 
‘The means to employ differ little from those indicated for fractures. 
Wherever possible, immovable bandages form the method of choice; 
‘they must always be resorted to on the extremities. In large animals, 
luxations of shoulder and of the hip are always difficult to hold reduced. 
‘With the first the iron splints of Bourgelat and the sticking mixture of 
Delwart are most recommended. Moveménts.and decubitus are to be 
cavoided ; hence the necessity to keep the patient in slings for some 
time. 
How long must the bandages stay in place? Some authors advise to 
-remove them after a few days; others say not before six weeks or two 
months. Early movements predispose to return of the trouble, and to 
-arthritis ; too long immobilization may bring on ankylosis and amyo- 
trophy. Not to count with the causes of failures, the bandage should 
be removed after two or three weeks, and the patient be allowed walk- 
