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Show NU DISLOCA'I'ION or rm: HUMEBUS. DISLOCATION or THE HUMERUS. «gum-«asp... .4 4w.» «3r; . ,'.,_.,..-v-..w ..-..--,o-.v .; - - w.--... be no twist given to the bone when the arm is by the side, consequently the ligaments are not burst up. 3. But the head of the bone may be lodged forward, that is, the arm may be bent backward, the ligaments burst up, and the force such as to direct the head of the humerus under the pectoral muscle. 41a Downward, or downward and forward, is the most com- mon position of the head of the humerus when dislocated. The reason is already explained, viz. that the arm can be extended in the opposite direction, that is upward and outward, and in that direction there is no check to the motion of the humerus but in the processes of the scapula : which however, being unequal to resist the force of so long a lever as the arm, serve only to throw the head of the humerus off the an ticulating surface of the scapula, and to tear up the ligaments of the joints. 171 pulled the more securely it grasps the arm*. It must take ' firm hold of the condyles of the humerus. An assistant standing a little above the level of the patient, takes hold of these laques, and pulls gently at first, increasing the force gra- " dually to the utmost. When the arm of the patient is somewhat fatigued, the surgeon takes hold of the arm with the right hand, placing the palm of his left on the top of the patient's shoulder; he directs the dislocated bone into that. line in which it was dislocated, i. e. elevated and a little backwards ; and increasing the force, he brings the arm round until its direction is forward and upward, when the bone will be in ge icrai reduced. The reduction is known by the audible jerk which the bone makes ; by the immediate ease of the patient, by the hollow under the acromion being filled up, and by the easy motion of the arm being restored. During this operation it may be useful to bend the elbow joint, and use the fore-arm like a lever to roll the humerus, which will in the first instance serve to disentangle the head OF THL‘ REDUCIIUX IN SIMPLE CASES. of the bone from its new connexions, and in the course of its motion towards the glenoid cavity facilitate the tubercles sailor‘s knot, in such a manner, that the more the ends are \ (pvt-'1' a? 'WM'" r.J0‘lp~ N-.~_ .3. ~‘ h" passing the edge of the scapula. WE shall not at present stop to consider whether there ought properly to be any distinction made in dislocation of the shoulder joint, but merely observe, that often a slight force by the hands of the operator is suflicient to reduce it. The cases of difficulty I hope shall presently be explained. The patient is seated in a chair; a table-cloth is put under the arm-pit and round the chest, while the ends are tied to some secure post or bench; a hand-towel is then put over the shoulder so as to press the acromion and scapular end of the clavicle ; the ends of this cloth are put round the larger table-cloth, where it crosses the back and breast; they are drawn tight there and secured. Something in form of a noose is now put above the elbow joint, and perhaps a hand-towel is the best thing we can use. It is twisted like a rope, and then applied in the form of a When the humerus is drawn out to that degree that the head is nearly on a level with the glenoid cavity of the sea- pula, and yet it does not slip‘into its place, we must vary the position of the arm by drawing the arm more upward, or What is the same thing, by allowing the shoulder of the patient to drop more, and the upper part of the trunk to [all a little to the side. Though I have found, that when the head of the humerus lodged against the margin of the glenoid cavity, that it was reduced by suddenly depressing the elbow, and lifting the head of the bone with my fore-arm, pressing upwards in the | axilla, yet I can see strong objections to it ; nay, often instead 0f facilitating the reduction, this position of the humerus *' It is a knot formed by twisting the cloth into two nooses, through which the arm is put, and on drawing the ends we have the {ii-most hold possible W ""1 ft"?a? |