282 DISEASES OF THE BONES AND ARTICULATIONS. 



accessory ligaments are seldom torn except in such cases where a 

 portion of the bone is torn with them. The cartilage of the joint 

 may be torn or detached in some cases by the subsequent inflam- 

 mation. The ends of the bones may be unaffected and in some 

 cases broken. Other alterations are seen in the muscles and ten- 

 dons in the neighborhood of the joint. They are abnormally 

 extended on one side and flabby oq the other side. They may be 

 torn, lacerated, or even crushed. It is only in rare instances that 

 the large bloodvessels and nerves are lacerated. The joints which 

 are dislocated are surrounded by a large quantity of blood which 

 infiltrates the tissues and is gradually reabsorbed. 



When reduction is not performed quickly — that is to say, the 

 displaced end of the joint remains in its abnormal position — we 

 have what is called nearthrosis as a consequence of the irritation 

 which it produces in the immediate neighborhood of the joint. In 

 such a case there is slight immobility due to partial adhesions of 

 the affected part, and also due to a certain extent to atrophy of 

 the muscles surrounding it. In some cases motion of the joint is 

 entirely lost. 



Clinical Symptoms and Phognosis. When a dislocation has 

 just occurred, and when it has been there for some time, tlie symp- 

 toms are more marked than they are in the intermediate stage, for 

 the reason that the hemorrhage produces so much swelling as to 

 render obscure, to a certain extent, the position and character of 

 the luxation. In some cases the condition can be very easily recog- 

 nized by comparing it with the perfect joint on the other side; at 

 other times, it is only by careful manipulation in the region of the 

 joint that the alteration can be felt. We may find a projection of 

 bone at one place and depression in another, where they do not occur 

 in the healthy side. We may even feel the luxated end of the 

 joint. In some cases where the deformity has been concealed by 

 the rapid swelling of the surrounding tissues, the leg may be 

 shorter, or it may be on a longitudinal axis with the other leg. 

 Another characteristic symptom is the loss of movement in the 

 luxated joint, especially when the case is seen early, although in 

 some cases where the ligaments have been so lacerated or torn, or 

 where a piece of bone has broken, there is abnormal flexion in that 

 part. This is especially important, as it enables, us to locate a 

 fracture of the bone that is in the neighborhood of the joint. 



