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Show .200 duced, our attention should be chiefly directed to restrain the rising inflammation, and to sustain the limb in its natural pesition by a splint and bandage. But I am bound to direct my readers' attention more particularly to what I have seen and practised. When the inner lateral ligament is partially lacerated, or even strained only, there comes upon the part, slowly, inflammation and relaxation. The patient feels great pain in walking ; the knee gradually falls inward, with increasing lameness. The yielding of the ligament on the inside of the knee joint being attended with increased obliquity of the thigh bone, the chance of further injury increases, until at every step the "eight of the body bears on the relaxed and inflamed liga0n dissection I have found the cellular substance and late: l'fll ligament, and capsule, on the inside of the knee much thickened. While they were thickened the ligamentous sub‘ . i stance was at the same time extended, so that there was not suflicient guard to the joint on this side. We understand that this thickening and inflamed state of the ligament, being a change of texture and constitution, it is followed by increasing weakness as an inevitable consequence of diminished density. The method of CURE therefore, will be in the first place to guard against. all repetition of the inju. ry, and to change this chronic inflammation. The first of these requires the application of a splint along the outside of the knee, with such a bandage around the lower part of the thigh and the upper part of the tibia, as may support the joint while there is no pressure made on the injured part. "Then the stiff splint has been used for a time ; motion may be allowed to the knee by a jointed splint applied like the former, which, while it prevents the yielding of the knee joint inward- ' iy, allows the natural flexion. .901 in machinery, the apophysis of the bones may be separated. I lately examined a case where a young man being caught in the spokes of a carriage by the leg while riding behind, had the lower end of the femur separated by diastasis. DISLOCA'I‘ION OF THE ANGLE JOINT. I HAVE already explained the nature of the compound dislocation of the ancle joint, where the lower head of the tibia has burst the deltoid ligament which protects the inner ancle, and the fibula is broken a little above the external ma- leolus. I have only at present to make some remarks on the degrees of injury to the joint. merit. r'w‘WI‘OWwaw...-.a_ DISLOCATION or THE ANGLE JOINT. srmm or THE KNEE JOINT. The second part of the design is accomplished by applying successive blisters to the inside of the knee. I ought, perhaps, to have mentioned under the. head of fractures, that if the knee joint of a boy be twisted violently 1. As in the instance just now stated of the injury of the lateral ligament of the knee joint, we have to notice the consequences of the lesser and partial sprains of the inner ligamerits of the ancle joint. If, in stepping on an unequal pavement, the ball of the great toe be not supported so as to make a balance to the external position of the heel, the foot is twisted, and the inner ligament of the joint is injured, and al« though not ruptured, it inflames and becomes weak. 2. I am often asked by my younger pupils what is to be done when the lower head of the tibia is actually forced from the astragalus, and the joint is laid open. Undoubtedly the practice is still to save the foot, and not to amputate. IVc replace the bones, and bind them, trusting that by bleeding and cold we can keep down the inflammation. No doubt circumstances of the patient's constitution and situation will . . qualify the rule. Will hospital, London a in and habit, bad a 3. A patient of be doomed to suffer amputation, when in other circumstances he might be saved. We must too in all such cases take into consideration the degree of contusion which the part has sutl fered. 4. If a man in leaping from a gig shall lacerate the ancle joint, the foot may be saved. VOL. is. c 2 Mail WON a" '3 .4 .s \4 i «asst |
