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Show 19; DISLOCATION or THE riuen BONE. DISLOCATION OF IKE THIGH BONE. the thigh bone, there can be no objection to the laques being. brought to the outside of the knee only. Whilst strong men pull the thigh by the laques in the line of the body, and an assistant holds the knee and ancle to give the rotatory motion, the surgeon should be placed with his hand on the joint; he may press down the trochanter, but he will do little good or harm by his efibrts there: he cannot press the trochanter down without at the same time pressing it to the back of the iliuni, which must have the effect of de- laying the reduction. . Sullieient elongation of the thigh I believe to be all that is absolutely necessary to reduction, but the elevation of the head of the thigh bone over the brim of the acetabulum will be much facilitated by the rotation of the thigh, especially by a pretty forcible jirk of the heel outward when the head of the thigh bone is brought to the level of the margin of the acetabulum. No cunning exertion on the part of the surgeon is required in this stage of the operation; the head of the bone goes with an audible snap into the socket ; the perfect relief satisfies the patient that the bone is reduced. He is inclined to take as little freedom in motion after reduction as can be required by the most cautious surgeon. 195 force as likely to be applied so as to displace the bone downwards as to dislocate it upward. When there is a resistance low on the. hip, and the trunk is forcibly twisted over to the same side, the thigh bone may be dislocated downward and forward : or, when a man is crushed down by a weight on the hip, or when the foot slips from un- der him, so that the‘ perineum touches the ground, the head of the thigh bone may be dislocated in this direction, viz. downward and forward. It the head‘of the bone is displau ed by its slipping over the lower margin of the acetabulum, it. must fall a little ,forwards and lodge on the thyroid hole. There can be no ditliculty in distinguishing this kind at dislocation from all other accidents to which the hip joint i-liable; the thigh is lengthened, and the knee and toe turned outward ; the limb straddles, and is with difficulty and pain brought to the line of the body. Unless the acetabulum is broken or diseased, there is no fear of the thigh bone again escaping from the socket. Tun thigh bone is sometimes dislocated downward and forward, so that the head of the bone rests in the thyroid hole, or rather on the obturator ligament and muscle. I con- ceive this to be a kind of dislocation less frequent than the last, though I see observations contradicting this opinion. It will be recollected, that the lower margin of the acetabulum is eked out by a ligament, but nevertheless that this part of the socket is not so well calculated to restrain the head of the thigh bone as the upper part of the circle. The diS-. location downwards, therefore, would often happen were the . r-W'"W:‘ ‘WWf-J‘ck .. p..." H- -. ‘3 . OF THE DISLOCATION OF THE THIGH BONE DOXV'NW'ARD. We have the explanation of all these circumstances in this sketch of the position 01' the thigh bone upon the iliuxn. A, the hollow of the os- itii; B, [he rirrdubzdunz [11/2 ("mpg/H C, the thyroid fOI‘n'illC‘ll,‘ D, (hehc‘ad rz/‘Ilzzjflwmr, dizn‘arJfril. and resting in the thyroid holy. |