LUXATION. 



has been weakened by tbe firfl copious bleeding, and to be by its having regained the power of performing certain mo- 

 tried again as foon as he has been a curtain time in the bath, tions impofTiblc during the didocatioii. For fome time af- 

 The faintntf^ and debiHty following fiich means, afTord the ter the reduction the limb (liould not be moved, except with 

 mod favourable opportunity for reducing a diOocation. the utnioll caution : a recurrence of a didocated (houldcr 

 The ftate of intoxication, induced by fpirits or opium, is has been known to arife from carrying the hand inadvert- 

 alfo well known to facilitate the reduflion of luxated bones, ently to the ff)rehead, by a fcmicircular motion, 

 by incapacitating the mufclcs to make nlillance, and put- The collation of pain has been confidered as a fign of the 

 ting ihem into a condition in which they yield and become reduction being clTefted ; but, as Boyer hasjuiUy remarked, 

 elongated by a very moderate force. Thus Boyer, by him- by cefTation, we are to underftand a conl'iderable diminution, 

 felf, and at the firll attempt, reduced a luxation of the arm rather than a total difcontinuance of pain. 

 of an intoxicated pollillion, while the affiftants were pre- Laflly ; one of the moll unequivocal and fatisfaftory in- 



paring the^npparatus for the reduftion. The plaii of pur- 

 pofely intoxicating patients, whofe diflocations cannot be 

 reduced by ordinary means, has even received the rccom- 

 mcndationo of fome furgical authors. 



dications of the reduction being accomplilhed, is the parti- 

 cular noife made by the head of the bone when it flips into 

 the articular cavity again. ', 



Alter a diflocation has been reduced, the grand ob- 



But, perhaps, of all the plans propofed for overcoming jeft that now prefents itfelf, is to keep the joint motionlefs, 

 the reliftance of the mufcles to the reduction of diflocations, fo as to hinder a relapfe, and give the torn ligaments an op- 

 fatiguing thofe organs by long continued unremitting ex- portunity of growing together again. All motion of the 

 tenlion is, when combined with due attention to the choice limb is, therefore, to be prevented. As the humerus can- 

 of fiich a pcfition as will relax the moll powerful ones, the not be luxated, except when it is at fotne diflance from the 

 moft effedtual that can be adopted. The ftrongefl mulclcs body, a return of its diflocation will be efFeclually prevented 

 may always be overcoiue by keeping up, tor a certain time, by tying the elbow to the fide of the body. The bandaj^e 

 even a very moderate degree of extenfion. The thing is employed for keeping the limb motionlefs, fhould always be 

 not to remit or difcontinue for a moment the operation of the made to operate principally on the end of the bone moft 

 extending power. This principle is faid to have been fird remote from the joint afTeCled. Thus, after a luxation of the 

 applied to praftice by Lebat, who, in a cafe where the leva- arm, when we apply to the elbow the means for keeping the 

 tores of the lower jaw were fpafmodically coiitrafited, in a bone in its place, we aft on that point cf the humerus the 

 diflocation of that bone, and would not allow the part to be moft diftant from its articulation with the fcapula, and the 

 brought down, introduced a fmall Hick between the teetli, force thus applied to the extremity of the lever, afts with 

 and making ufe of it as a lever, oppofed theaftion of the much moreeffefl. The fame rule fliould be obferved in the 

 mufcles^until they were incapable of further relillance, and application of a bandage to the chin, after a luxation of the 

 the reduftion was accompliflied. M. David is alfo dated jaw. Indeed, in this laft cafe, fuch praftice has been re- 

 to have derived fimilar advantages from the fame pradlice, in conimended by all furgical writers ; but in diflocations of 

 luxations of the thigh and arm. the fhoulder and hip, they-feem to have forgot the utility of 

 When luxations have been left unreduced feveral days, the principle, and have generally adviCcd that moft inert 

 the reduction frequently becomes exceedingly difficult, and bandage termed the fpica, which only adts on the centre of 

 fometimes quite imprafticable. The lacerated opening in motion, and, confequently, can have little or no effeft in 

 the capfular ligament, after a time, becomes clofed, ■and thus keeping the bone fixed. 

 a material impediment to the reduiSion is occafloned. When When a luxation arifes from an internal caufe, fuch as pa- 



.a diflocation has exifted for weeks and months, many circum- 

 ftances take place !0 prevent the poflibility of reduftion : 

 the head of the bone acquires coi.nediions in its new and 

 unnatural fituation ; the mufcles become incapable of fuffi- 



ralyfis of the mufcles, aloofenefs of the hgamcnts, or general 

 debility, the duty of the furgeon is to endeavour to obviate 

 the caufe by fuitable remedies, as well as replace the bone. 

 We confefs, however, that we know of no medicine nor 



cient elon:;ation again; and, what is worfe, the articular application that feems to be calculated to remove a lax ftate 



cavity iiifFers more or lefs obliteration. In the gingiimoidal of the ligaments. 



joints, an anchvlolis is foon produced, and the reduftioii Luxations, in general, are particularly liable to be accom- 



rendercd impradticable. We have feen many attempts made panicd by more or lefs contufion of the foft parts ; and 



■with multiplied puilics to reduce old diflocations. . In a few they are lomctimcs cou'.plicated with inflamination, rupture 



inftances, a degree of benefit was thought to have been the of blood- veiTels, injury of nerves, and even a frafture. The 



refult ; but in no inllance «as the fuccefs complete. Thefe latter complication is not frequent, but when it does occur, 



luxations, however, might have exifted an unreajfonable the bone has always been luxated firft, and afterwards broken 



length of time. It is difficult to pronounce exactly how by the violence. The paralyfis arifing from a contufion of 



long a diflocation of the arm or thigh muft have happened, the nervts is not an uncommon confequence of diflocation of 



to juftify the abandonment of all attempts at reduction, the flioulder ; and when we confider the relation between 



The celebrated French furgeon Default fucceeded by the thp.head of the hum.erus and the brachial plexus, the occur- 



prudt-nt employment of force in reducing many cafes which rence is by no means furprifing. 



had exilled for feveral months ; and fuch tafts call upon the Boyer obferves, that when a luxated bor.e is not reduced, 



praftitioner not to give up at' once every old diflocation as fometimes it remains in the place into which it has been 



paft relief. A patient's means of fubfillence, ior himfelf and forced; but much more frequently it changes its fituation, 



his family, wfll often entirely depend upon his luxation being and is carried fiill further from the cavity of the joint by 



reduced. In the gingiimoidal joints, as we have already ob- the aftion of the mufcles. Thus, in luxations of the thigh 



ferved, luxations fooner become irreducible : according to upwards and outwards, the glutei mufclcs continue to draw 



Boyer, after twenty, or four-and-tweniy days, they, in ge- the head of the thijili-bone up along the dorfum of the 



neral, cannot be replaced, owing to an anchylofis having ilium, until the hmb is fliortened as much as the parts will 



occurred. allow. 



The furgecn knows, that a luxation is reduced by the limb But, as the fame furgeon has explained, whether the head of 



having recovered its natural length, ihape, and dirtttion, and tlie luxated bone preferves its firil polllion, oi takes BHOther, 



it 



t^ 



