LUXATION. 



When unufual difficulty occurs in difengaging the condyles 

 from under the zygomatic procefres, owing to the refillance 

 of the mufcles, Le Cat's plan for overcoming and fatiguing 

 thefe powers may be purfued ; it confifted-'in introducing a 

 fmall Hick between the teeth, and ufing it as a lever for 

 combating the aftion of the mufcles, until they were quite 

 exhaulled. Here the furgeon is not required to ufe violence, 

 which might break the teeth, but only to keep up a mode- 

 rate and unremitting extenfion of the refilling mufcles. 



According to Mr. Hey, if both fides of the lower jaw are 

 deprefled, while one fide only is diflocated, the reduftion of 

 the luxated condyle is ratiier prevented. The force (hould 

 be applied to the affefted fide alone. See Praft. Obferv, in 

 Surgery, p. 326, edit. 2. 



JLii.valions of the Verlebfie — The large furfaces by which 

 thefe bones touch each other ; the number and thicknefs of 

 their ligaments ; the ftrength of the mufcles lying on the 

 column formed by them ; the fmall motion of which each 

 vertebra is capable ; and, lallly, the vertical direftion of 

 their articulating procefles (fays Boyer), render a luxation 

 of them in the dorfal and lumbar part of the column entirely 

 impoflible. A violence, though ever fo confiderable, cannot 

 difplace them, without firll frafturing them. But this is 

 not the cafe with the cervical vertebrae ; the extent of their 

 articulating furfaces is lefs ; the ligamento-cartilaginous fub- 

 llance which unites their bodies has more pliability ; the 

 motion of their articulations is greater ; and their articulat- 

 ing furfaces have an oblique direftion, which allows them to 

 have an obfcure rotatory motion. Hence luxations of the 

 cervical vertebrse fometimes prefent thcmfelves in praftice. 

 Boyer has feen a luxation of the middle cervical vertebrae 

 caufsd by a violent rotatory motion of thefe bones. 



Luxations of the Head from the jirjl Vertebra. — The jomts 

 between the occipital bone and iirft: vertebra of the neck, 

 or atlas, are itr-'ngthened with numerous ligaments, and 

 only admit of very limited motion. We have.no inftance of 

 luxation of the head from the firft vertebra by an external 

 caufe, and fuch a diflocation, were it ever to happen, would 

 inftantly deftroy the patient, by comprefliiig and injuring 

 the fpinal marrow. But, as Boyer has remarked, nature, 

 which cannot bear fo fudden a change, is habituated to it, 

 when it takes place gradually, and the fpinal marrow which 

 would be fatally hurt by a fudden didocation of the head 

 from the atlas, is capable of bearing the fame kind of luxa- 

 tion that is infenllbly and flowly produced by difeafe. 



Luxations of tlic Jirjl cervual Vertebra from the Second. — 

 The motion of the head to the right and left is principally 

 executed by the firll vertebra turning on the fccond. The 

 laxity and weaknefs of the ligaments between thefe bones, 

 and the direftion of their articular proceffes, tend to facili- 

 tate this kind of rotation, which motion, indeed, would fre- 

 quently be carried beyond due bounds, and a diflocation 

 happen every time that we turn our heads, were not the 

 motion confined by the very thick ligaments which go 

 from the fides and fummit of the procelTus denlatus of the 

 fecond vertebra to the edges of the great occipital hole. 

 As Boyer obferves, when this motion is forced beyond its 

 proper limits, the ligaments are torn, and the lateral parts 

 of the body of the firft vertebra glide along on the arti- 

 culating horizontal proceffes of the fecond. If the head is 

 turned from the left to the right, the left fide of the body 

 of the vertebra is carried before its correfponding articulat- 

 ing furface, whilft the right fide falls behind its correfpond- 

 ing furface. In this luxation, fometimes the proceflus den- 

 tatus, the ligaments of which are broken, leaves tlie ring, 

 formed for it by the tranfverfe ligament and the anterior 

 iurch of the firft vertebra, and prefles oa the fpinal marrovr. 



In other examples, it doe« not quit the ring ; but the dia- 

 meter of the vertebral canal is always diminiflied at the place 

 of the diflocation, and the fpinal marrow injured or lacerated. 

 It is readily conceivable, that the patient cannot furvive an 

 accident of this nature, every wound of the fpinal marrow, 

 in fo high a fituation, being quickly fatal. 



The celebrated M. Louis found, that the criminals who 

 were in his time hanged at Lyons, periflied by the luxation 

 of the firft vertebra from the fecond ; whilft tliofe hanged 

 at Paris were fuffocated by ftrangnlation. He difcovered 

 that the caufe of this difference was owing to a rotatory 

 motion which was given to the body of the culprit by the 

 executioner at Lyons, the moment it was fufpended. J. L. 

 Petit mentions an inftance in which a boy, between fix and 

 feven years of age, vi-as killed in an inftant by a luxation of 

 the firft from the fecond vertebra, brought on by the boy 

 ftruggling, whilft a perfon was raftily lifting him up by the 

 head. This laft trick cannot be too feverely condemned as 

 a moft dangerous experiment. 



There are other luxations of the neck not followed by 

 death ; but in thefe cafes, the diflocation takes place in the 

 third, fourth, fifth, or fixth vertebra, and only one articu- 

 lating procefs is luxated. Some examples are quoted by 

 Boyer, which were confidered as cafes of this laft defcriptioPf 

 being attended with a diftortion of the head to the right or 

 left, without any fpafm or rigidity of the fterno-cleido- 

 maftoideus mufcle. 



When luxations of the cervical vertebrs produce no 

 fymptoms indicating a dangerous degree of preflure on the 

 fpinal marrow, it is prudent not to attempt the reduftion, 

 as the patient may be killed in a moment by the endeavour, 

 in confequence of the fpinal marrow becoming fuddenly com- 

 preffed and injured. If the fymptoms, however, make it 

 probable that the patient's only chance of life depends on 

 altering the pofition of the luxated bones, the furgeon ought 

 cautioufly to attempt the reduftion. Fortunately, thefe 

 cafes are as unfrequent as they are perplexing, and we ftiall 

 omit, as uninterefting to the praftical furgeon, the ufual 

 direftions refpefting the mode of reducing fuch accidents. 

 It is enough for the furgeon to be duly aware of the peril 

 that accompanies the attempt. 



Lu.vat'ions of the Bones of the Pihis. — Thefe bones are 

 fcarcely fufceptible of luxations. The os facrum, firmly 

 fixed between the two ofTa innominata, cannot poffibly be 

 diflocated. The os coccygis is more eafily fraftured than 

 luxated. The latter accident, however, has fometimes been 

 obferved. Boyer has feen it induced by floughing and 

 difeafe, which denuded the bone, and evinced that there was 

 a fpace of nearly two inches between the extremity of the 

 facrum and the bafe of the os coecygis. But, in the end, 

 the two bones grew together again. Much has been written 

 by authors concerning a relaxation and yielding of the fyro- 

 phyfis pubis and facro-iliac articulations in the advanced 

 ftages of pregnancy. We leave to the accoucheur the 

 determination of this matter, as it is only indireftly cannefted 

 with the fubjeft of luxations. 



When we ftated that the bones of the pelvis were hardly 

 fufceptible of luxations, our meaning was of courfe confined 

 to the effeft of ordinary caufes. Great external violence, 

 afting diieftly on any part, will make every thing yield. 

 Thus, in tlie fourth volume of the Memoirs of the French 

 Academy of Surgery, an inftance is recorded, where the 

 right OS ilium was diflocated from the facrum, three inches 

 backwards, by a fack of wheat, weighing three hundred 

 and fifty pounds, falling on the back of a labourer. The 

 patient died on the twentieth day, and the luxation was 

 proved by difleftion. The pelvic vifccra were found in a 



ilate 



