| OCR Text |
Show 196 annucrlox or Tm: mien BONE. REDUCTION or me 'rmon BONE. or run REDUCTION or THE THIGH BONE WHEN DISLOCATE'D DOWNWARD. THE reader might imagine, that as the limb is already too long there can be no necessity for applying an apparatus, to stretch it as in the last instance ; nevertheless, the position, the manner of securing the patient and of applying the laques to the limb, may be the same in this case as in the last ; that is, on the idea that the limb must be somewhat further stretched before it can be reduced. But it requires to be particle larly noticed, that in this instance of dislocation of the thigh bone downward, the head of the bone must be lifted from the place in which it is lodged, and raised to the level of the acetabulum before it can be reinstated in the socket. It might at first appear, that by using the thigh bone as a lever, the ramus ischii being the fulcrum, it would be possible to raise the head of the bone from the thyroid hole by pressing the thigh backward and inward. But when we consider the p0» sitiou of the knee and toes, it is evident that the great trochanter is carried so far downward, that by this motion it 1S. 1. i i f K ,. {not do: would be carried under the ramus of the ischium, and that consequently, the reduction would be checked and impeded. A fulcrum, or fixed point, must therefore be supplied to enable us to operate with effect in this position of the limb and trunk. For this purpose a large towel or table cloth is put round the thigh, and carried as near the perineum as may be. The ends of this cloth are to be held up by strong assistants. While the thigh is gently drawn so as to extend it, the cloth is at the same time raised and carried a little backward, so that the head of the thigh bone may be lifted from the de~ pression in which it lies. The thigh is then bent (by carry~ ing the knee forward) and drawn in that direction ; our last resource is to carry the knee to the ground, that is, toward: the other side of the patient's body. In this operation we make the cloth which is put under the upper part of tht thigh, a stay, or fulcrum, and by using the thigh as a lever . r'w~‘:‘ 'va'f"‘w y. "at"... .... "a" . . manna-.7":- 9"" mun-aw" a- :- -«- ,A »~ i Si ‘ 193' we unfix and raise the head of the bone. We may during this operation, roll the thigh by taking hold of the knee and ancle as heretofore described. We may perhaps find reason to prefer the following method of reducing the thigh bone when dislocated downward. The patient is set upright on his breech, his thighs on each side of a strong pillar ; or he may be seated on the corner cl 3. bed, the bed-post betwixt his thighs ; something soft is wrapt round the post, and a person is placed behind him to prevent him from reclining backward, and to keep him to the seat. The extension of the thigh is accomplished by drawing it at right angles with the trunk. My reader will readily un- derstand that by this operation the head of the thigh bone is drawn out of the hollow in which it lies, and lifted as it were into its proper socket. If drawing in this direction simply does not succeed, then the cloth is at the same time to be put round the thigh as before, so as to draw the head of the thigh bone outward, while the knees are brought together. There is mention made of a kind of dislocation which, when looking on the subject, I should say is little likely to happen-the dislocation of the thigh bone upward, while the articulating head is forward on the ilium, and the trochanter backward ; it will be characterised by the union of the two most distinguishing signs of the other kinds of dislocation, viz. the shortening of the limb while the knee and toes are turned outward. When the thigh bone is reduced there is little tear of its starting again from its place; all that is done on this account is to put some slight binding around the thighs to check their motion. What is to be feared is inflammation in the joint, and gradual wasting of the head of the thigh bone, of which I have lately seen a case. This I must suppose owing to some badness of constitution. I would treat it as the con secutive dislocation, viz. where the head of the thigh is displaced in consequence of diseased action filling up the meta bulums "Wilt/"'05". |
