L U X A T I O N.- 



....,; even the fl<iii which covers the articulation, may be to be applied immediately above the luxated bone. Some- 

 lacerated, and the moll direful fufferings occafioned. times the countcr-extenfion is made by afliftar.ts, who take 

 Altliough the writer of this article fully afTcnts to the hold of tlie bandage neceffary for the purpofe ; fometimes it 

 general fiiperiority of making the extenfion by the affiilants, is executed by fallening the bandage to a fixed point. The 

 he cannot refrain from expreffing a favourable opinion of latter mode, when practicable, is to be preferred. The 

 the convenieuce and efficiency of a pulley, in cnles where counter-extenhoii fliould always be made in a perpendicular 

 inteUigent afTillants are not at hand, and where much force is direction with refpedl to the furface of the luxated joint, 

 required for the reduition, as, for inftance, when the thigh- In a luxation of the elbow, for iiiftunce, the counter- 

 bone, or humerus, has been out of its place fome time, or extenfion (hould be made in a line parallel to the os humeri ; 

 when the patient is very mufcular and llropg. At the fiune and in a diflocation of the thigh-bone, the counter-exienfion, 

 time, the dangerous confequences which may happen, when applied to the pelvic, (hould be made perpendicularly to the 

 a rough, unflcilful, or impatient practitioner dares to employ furface of the acetabul im. The fame rule is to be obferved 

 a pulley, cannot be too deeply imprcffed upon a furgeon's with regard to the fhoulder in luxations of the humerus, 

 mind. Whether extenfion is made in the ordinary way, or In general, when the extenfion is fuffi.ient, coaptation is 

 with a pulley, it fhould be made with moderation, as the eafily performed. In a luxation of the humerus, as the 

 miifcles are more fure of being fafely overcome by length of head of the bone is difengag^d, and the afliftants have 

 refiitance than by the exertion of violence. brought the bone into its natural direftion, the furgeon is 

 It is impoitible to affign the precife degree of force to be to feize the opportunity, and with one hand prefs on the 

 employed ; it is to be varied and proportioned, according fuperior and inner part of the arm, ivhilll, at the fame time, 

 to the ilrength of the patient, and the number atid force of he iupports the elbow with the other, and thus condufts the 

 the mufcles furrounding the articulation. Ic has been faid, head of the bone ii^to the glenoid cavity, 

 that, m reducing a luxation, there is occafion for more ad- It is an excellent maxim, whenever prafticable, to ufe a 

 dreis than force ; it would be true, obferves Boyer, to fay, diflocated bone as a fort of lever, in makino- the reduAion. 

 that the union of both is iieceffliry. Often fix afiillants Thus, after the head of the humerus has Ijeen difenga^ed 

 accomplifh that which three cannot do, and nine or tt-n per- by the extenfion, if, while prclTurc is made at the upper 

 form that which cannot be done by fix. and inner part of the arm, tlie elbow is deprefied, the head 

 With regard to the direction in wliich the extenfion fhould of the bone moves upwards in proportion towards the 

 be made, Boyer recommends it to be at firll the fame as that glenoid cavity of the feapula. The recoUeClion of this 

 which the luxation has given the diilocated bone. Suppofe principle will materially aid in reducing diflocations of the 

 the head of the humerus to be luxated inwardi>, and forced jaw, thigh bone, &c. Common fenfe pointf'out, in almoft 

 into the folia fubfcapularis, between the fubfcapulans mufcle every cafe, how and where the fu'crum fhould be made, 

 and the feapula : in this cafe, the elbow is not only moved Luxations of ginglimoidal articulations being feldom 

 out from the trunk, but even carried backward-. Now, if complete, the extenfion and counter-extenfioii are generally 

 we were to commence the reduction, by pulling in the na- made, in fuch inftances, only with a view of diminifhing the 

 tural direction of the humerus, that is, directly outwards, friCiion of the furfaces of the joint, ncceflarily occafioned by 

 the head of the bone would be prefTed againit the folTa the oppofite motions given them, with a view of -replacing 

 fubfcapularis, it would not eafily Hide along, the force woiiid themin their natural fituation. 



be fpent in pufliing the feapula backwards, and the irrita- When extraordinary difficulty is encountered in reducing 



tion would excite the contraction of the mufcles fituated a diflocation, the furgeon (hould endeavour to afccr'.ain the 



near the luxated head of the bone. caufe. Sometimes want of fuccefs is owing to the infufE- 



Extenfi jn, then, is generally to be made at firfl in the di- ciency of the means employed, in which circumftaucc, we 



reftion which the luxated bone has taken ; but in propor- 

 tion as the mufcles become elonga'ed, and yield to the force 

 acting on them, the bone is to be gradually brought back 

 into Its natural pofition. In this manner the head of the 

 bone is difenga^ed from the parts m which it has been 

 placed, and is brought back to the cavity which it has left, 

 by making it defcribe the fame courfe that it took in making 

 its efcape. 



We are now to confider what is termed counler-exlenfion. 

 As Boyer has juilly remarked, the belt directed exten- 

 fion will be ufelefs, if the bone with which the luxated one 

 has been articulated, is riot kept motionlefs by counter- 

 extenfion, a force equal to the other, but made in a con- 

 trary direction. The counter-extending power, applied to 

 the luxated bone itfelf, would be attended, in almolt every 

 cafe, with the double inconvenience of producing a fpaf- 

 mod"ic contraction of the mufcles, and preventing the elong- 

 ation of them neceffary for reduction. Let us fuppofe, 

 fays Boyer, that in a luxation of the thigh, the counter- 

 exteiidmjT banda^je were in the fold of the groin of the 

 afi'jCted fide, the confequence would oe, that the triceps and 



mull either increafe the extending power, or diminifh the 

 mufcular force of th^ patient. 



The latter object may be fulfilled in various ways. 

 Change of podure often produces the efleft. In Boyer's 

 work itillances are mentioned in which patients, while leated 

 on a chair, and fupporting themfeives with their feet agau.ft 

 the ground, could not have their luxations reduced with the 

 greatefl efl\)rts ; and yet afterwards had their dillocations 

 reduced witli iinexpeded facility, on being laid horizontally 

 on a long fixed table, where their mufcles were deprived of 

 a centre of motion. In general, however, the benefits of 

 polture may, with more reafon, be impiited to its relaxing 

 the mofl powerful mufcles oppofing the endeavours of the 

 furgeon. 



When eivery attempt, conduced on the forcgoinsr prin- 

 ciples, proves mefiectuai, the patient is to be largely and 

 repeatedly bled, be put into the warm bath, and confined to 

 a very Ioa' diet. As focui as he appears to be confidjfrably 

 weakened by this plan, the diflocation, which was previoufly 

 irreducible, may freque.iily be reduced with" the utmofl eaie. 

 We do not coincide with Boyer, when he adviles us to lofe 



gracilis, which are in a Hate of tenfion between the pelvis twenty-four hours in. lowering the patient, before renewing 

 and thigh, would be pufhed inwards, and, confequently, the attempts at reduction. On the contrary, fo fuliy are we 

 fhoitened, when their elougation is abfolutely neceiiary. Be- convinced of the difficulty of leduition, always proceeding 

 fides, the comprcifion made on them would alfo increale their from delay, that we earntlUy recommend the eflorts to re- 

 • v.traaion. The counter-extending force ought, therefore, duce the bone to be renewed immediately after the patient 



hat 



