LUXATION. 



tufion of the circumflex nerve, in a luxation of the humerus 

 downwards and inwards. 



We have now to confider the general treatment of lux- 

 ations. 



To reduce the diflocated bone, keep it in its place, and 

 prevent or remove the fyniptoms with which the luxation 

 may be complicated, form the three indications which are to 

 be fulfilled in the treatment of luxations. The reduftion is 

 accomplifhed, as in cafes of frafture, by three means, op- 

 pofite in their aftion, but tending to the fame end, viz. ex- 

 tenfion, counter-extenfion, and coaptation. 



In the article Fracture we have expatiated a good deal on 

 relaxing the mufcles connefted with the broken bone, in 

 order to facihtate the reduftion of the frafture. This great 

 principle, which was fo much and fo juftly urged by Mr. 

 Pott, holds equally good in cafes of diilocation. From the 

 adlion of the mufcles principally arife all the trouble and 

 difficulty which attend the reduflion of luxated joints. 

 The mere bones, compofing the articulations, or the mere 

 connefting ligaments, would in general afford very little op- 

 polition. It is the mufcles that chiefly oppofc the rcdudlion, 

 and their refiftance mull either be eluded or overcome ; terms, 

 fays Mr. Pott, of very different import, and which every 

 praftitioner ought to be well apprized of. We fcarcely 

 need add, that this eminent furgeon was a ftrong advocate 

 for relaxing the mufcles belonging to the difiocated joint, at 

 the time of attemptmg to reduce the bone. Now, although 

 this precept is, generally fpeaking, nioft excellent as far as 

 it is praflicable ; we are not to run away with the idea that 

 things are precifely as Mr. Pott has reprefented them to be, 

 in his general remarks on fraftures and diilocation. No fur- 

 geon, of the prefent time, is fo abfurd as to nnagine that 

 merely bending the elbow, or the knee, will relax all the 

 mufcles which have the power of refilling the redudlion of a 

 diflocated fhoulder or hip. Neither will the mott advan- 

 tageous pofition for extenfion always allow the poilure to be 

 entirely regulated with a view towards the relaxation of the 

 mufcles. While, however, we profefs thefe fentiments, wc 

 feel a thorough conviftion that attending to the relaxation of 

 fuch mufcles as have the greateft power of oppofing the re- 

 duftion of a diilocation, is an urobjeftionable maxim, as far 

 as it can be received in aftual praftice, confiflently with 

 fome other equally important objefts. When Mr. Pott 

 wrote fo flrenuoully in favour of relaxing the mufcles, or, as 

 we fhould rather fay, of bending joints, in cafes of difloca- 

 tion, it was alfo neceffary for him to lay much ftrefs on the 

 advantage of applying the extenfion to the end of the diflo- 

 cated bone itfelf ; becaufe, were it applied in a better fitua- 

 tion, the bent pofition would become inadmifTible. The 

 reafon which is affigned for this pradlice, however, is, as 

 might be expecied, moll weak. Mr. Pott talks a great deal 

 about the liilutability, or dtjlranile power of the ligaments, 

 and their capacity of giving way when flretched or pulled, 

 much more, we think, than faCts jutlify, fince it is the ge- 

 neral nature of ligaments, we mean fuch as aflualfy hold 

 the bones together, to be very ftrojig and unyielding. The 

 capfular ligaments, we think, are generally to be regarded 

 rather as bags for the fysovia, than asa means of flrengthen- 

 ing the articulations. The yielding nature of fuch liga- 

 ments, therefore, can have little to do with the fubjcft of diflo- 

 cations. Now it appears to lis that Mr. Pott was anxious 

 to make the ligaments appear more elallic than they really 

 are, in order that he might reprefent all the extending force 

 applied to the bone below the diflocated one, as being lofl 

 in the intervening unluxated articulation. Even were the 

 ligaments of the knee, for inftance, to yield in the manner 



infinuated by Pott, when the extenfion is applied to the lower 

 part of the leg, the extending force would l>ill not be loll, 

 but would operate with full effeft on the thigh. Where is 

 it lofl ? The very circumflance of the ligaments being on the 

 flrctch, proves that the force operates on them, and they 

 being attached to the os femoris, thishone cannot fail to re- 

 ceive the extenfion in a degree precifely equal to that with 

 which the ligaments themfelves receive it. It is extraordinary 

 that reafoning fo abfurd fhould have impofed upon the gene- 

 rality of fuigcons in this country; cfpeciallyas on the conti- 

 nent, its faHliY has long fince been expofed in the writings 

 of Fabre, Dupony, Default, Boyer, and Rich^rand. The 

 doftrine of Pott is the mofl ancient ; but the antiquity of 

 any praftice fhould ceafe to be a reafon for a perfeverance in 

 it, the moment the principles, on which it is founded, are 

 proved to be erroneous. 



We differ then from Pott, and believe with the moft 

 confummats furgeons on the continent, that the extending 

 force fliould be apphed, not on the luxated bone, but on 

 that with which it is articulated, and as far as poffible from 

 it. 



All the ancient autliors, as Boyer remarks, advifed ap- 

 plying the extending force on the luxated bone, for inftance 

 applying it above the knee in luxations of the thigh-bone, 

 and above the elbow in thofe of the humerus. Many of the 

 moderns have followed their inflruftions ; and this mode is 

 found recommended by J. L. Petit and Duverney in their 

 treatifes on the difeafes of the bones. Two members of the 

 Academy of Surgery m France, Fabre and Dupony, faw 

 the inconver.ience of this praftice, and fubflituted for it a 

 mode of treatment now generally adopted on the continent. 

 Their praftice, which confills in applying the extending 

 force to the bone that articulates with the luxated one, has 

 two mofl important advantages ; firfl, the mufcles which 

 furround the luxated bone are not compreffed nor flimulated 

 to fpafmodic contraftions, which would prevent the re- 

 duftion, not only by oppofing a force fuperior to that em- 

 ployed for the purpofe of reduftlan, but alfo by retaining 

 the head of the bone engaged in the interllices of the con- 

 trafted mufcles. Secondly, the extending- force is much 

 more confiderab!e than it is in the other method, for, as Du- 

 pony hasobferved, by elongating thus the arm of the lever, 

 we acquire a degree of power which the difSculties prefented 

 in a great number of cafes force us to have recourfe to. It 

 is true, fays Boyer, an apprehenfion has prevailed that the 

 extending force applied at a diflance from the luxated bone, 

 would lofe in the articulations of the lim.b a part of its effeft. 

 Thus it has been alleged, that apart of the extending force 

 applied at the wrill, in a luxation of the humerus, is cm- 

 ployed in elongating the ligaments of the elbow joint. But 

 this objeftion is ill founded ; all the mufcles which go from 

 the humerus to the bones of the fore-arm, by ffrengthcning 

 the elbow, make it anfvveras a continued lever, along which 

 the force is communicated without any lofs. 



Force, applied by the hands of intelligent and fhong 

 afTiflants, is generally confidered preferable to any mecha- 

 nical means in the reduction of diflocations. The number 

 of alTillants may be increafed at will, and force propor- 

 tioned to the refiftance that is experienced. Should there 

 not be room for a fufficient number to take hold of the 

 limb, they may make the extenfion by means of a napkin, 

 or fheet, folded longitudinally and tied on the limb. It is 

 faid that the force employed can be better judged of when 

 the extenfion is made by a certain number of afTiftants, than 

 when a midtiphed pulley is ufed, which may act v.ith fuch 

 force, without our being aware that the mufcles, ligaments, 



and 



