1000000031

6¡'r

(000

.s lhe redullion ha, been by lhe(e means e/fell–

ed, the articulation mult be bound up with a

proper

bao–

dage, and the

arOl

is ro be afterwards

furpcnded

in a nap–

kin or Oing about the neck:

bUl

care mult be takcn, th"t

che bandagc be

nal

fuffercd

be on

tOO

long, nor

lhe afro

lo be kepl all lbe lime lIdl, WilhoUl (ome gentle mOlion.

L UXAT IO NS

oflhe

HAND, CARPUS, MliTACA'RPUS,

and

FINCERS.

NOTWITH STAHDINC

the hand is very accurately con·

nefled

the two preceding bones, aod puticularly to the

radiuJ,

means of the

carpuJ

and

aroog

li~aments.

yet

fometimcs fuffers luxatíon in al! (our direflions

but

generally nOl (o ea(y

be luxaled on cilber fide, as (or–

ward or b.lckward, becaufc of lhe two procelfcs of lhe

ra–

Jiul

and

u/na,

which guard

on each

fideo

The hand

raid

to be

luxatfd

forwa rdJ

in1IJOrdJ

when

rccedts

{rom lhe mu(cles which beod lhe fingers; to be

lu".ted

6adward,

when it departs {roro the muCcles whicb extend

the fingers: much

alto

io lhe Carne manDer, lhe hand is

jujged ro be

Jux"t~d

out'Wara,

when the

carpU/

makes a

tumor near the thumb, and a cavily near the liule fi Dger;

to be

luxatea in'Wa,.d,

when the contrary happens.

(eem.

be lhe ra(dl way immedoalcly

reddce whn

is dilplaccd ; and Iha.t tbis may fuccecd the better, two

tbiogs are

be chieAy regarded: (lo) Thal lhe luxaled

band be fufliciently eXlended

lWO .fIirtanlS, one of wbich

lay hold of lhe hand, and lhe olher of lhe

hum"ul,

pulling iD oppoGle direllions:

(2.)

Thal lhe par! of lhe ex–

tended hand, where ,be

jinuJ

¡s, be pl dcrd

atable. or

fome olher

Ha!

body, lh.. whaleycr Illck. up may be de–

prelT,d: by which melhod lhe hand, in whalever par! lux–

ated, may be 'fery readily reduced ioto iu natural Ceat.

alfo fomelimes happens, thu one or two c..f the eight

little bones of the

carpuJ

are luxated and di{lo, tcd from

their natural {eat by forae external violtnce, When Ihis

bappens, Ihere will De perceived a lomor in one pan, and a

cavity in anoiher, which may be alCo fdt by lhe fingers ;

befides, . iolenl pain, wiU be reh by lhe palienl. Fgr Ihe

ren. a, Ihis kind of Juxation is very eafi ly dlfcoTered, part–

Iy by lhe Coghl, and partly alfo by feeling ; fo, when il i.

reccnl, il IS almon as readily cured, Jettíng the h.lOd be ex.·

tended

the manner wc before propo{ed, and the

dIAoc~·

ted bone be afterwards forccd iato

ilS

pl4lce.

The (our Cm:lll bones. which 4Ire found in the

me/acar·

PUl

or pal m of lhe hand, may be fomelime. luxated from

the

'car}ul

itfelf. tOwhich their upper pans are conntét_ed ;

which u(.aUy happeos (rnm (ome eXlern,1 .iolence. The

two bones which are fcated in lhe middlt belween the I\VO

other external ones, cannot be d.clucaled

tilher ridt"; as

the IWO external ones which fllllain the rirlt and lill le 6n·

gen caonot bé luxated inwardly, bUI are more e¡¡rily driTen

oUl.,ard : lhough ••ch of lhem

m, y

be luxalcd on lhe fore

or back pan of the hand. Hut which ever

Ihefe hílpptns,

the pa.rticular di(order may be dlfcovered anrt exanllned by

fecling and iafpe{tiog, and Ihe cure may be carru:d on in

altogether lhe Carne rrJelhod whkh we direéteo b:fore,

Lartly, The

bone~

of lhe fingers, tO which \Ve join tho{e

of the thombs, are liable to luxalion í\l

e~ch

of their drt!a

culatioDs, and that in {everal dird\ions.

BlI~

IheCe acci–

deDtS, if recl!nt, are both Tcry cafy tO difcovcr .loI1d cure:

for che llgame:nts bcing not very robult, f,he

(~t

au I mur

des

tbiD, aod

lhejill''ftl

of lilo aniculalion, Olallow,

r~D-

dcr lhe exteaGan very

{y,

2nd lhe rcduélion of them inrb

lheir (o'rmer places may be done very re.dily. While one

hand of the furgeon extends the 6nger, he Hrives with his

other

replac~

lhe banes in their

natur~1

feat.

Ofa

LUXATION

of the

THICH.

V ..

rare is il lhal lhe head of- lhe lhigh_bone is di(–

placc:d out of iu

ace/aDulum;

though (ormerly il \Vas {up–

po(ed

be prwy ' requeol, phyficians taklng a (rallure

thereof for a luxatiun, the rea.fon \Vhereof may be ukeo

(rom'lhe . "iculalion il(elf:

(l.)

HolV very deep is lheft–

nUI,

called by

~hc

anclents

.finuJ

COXtr

and by the

Olad~rns

aettalm/ulII,

ioto _which lhe head o( lhe thigh-bone is rea

celVed,

(2 .)

Wi,h whal a broad concave ctHtilage is

1.1-

mol! lhe whole head of lh.. bone covcred.

(3.)

Ho'"

I!rong are lhe ligamenlS Wilh IVhich il is (alleoed .

(4 :)

How gready il is defended wilh excceding lIoul and lhlCk

mu(cle,.

(5.)

BUl how very brinl. i.lhe neck of lhis borie

beyond any other part thereof: (rom all which

appears

lhal lhe . eel, mul! be far mnre freque ndy and eafily broke,

efpecially in adul", lhan ilS head dlllocaled: and lhough

fomething of this kiDd may fornetimel happen,

make

lhe held of lhe lhigh-booe nlp OUl of ilS

nctlabulum;

ye,

that genenlly procceds more (rom ínternal lh:\n externa!

cau(es: (or we find

has beco obfcrved by very O,ilful phy–

liciA"', that the Jigamenu of lhe thigh.bone, thollgh very

firoDg. may be by various caufes, and panicularly by a flu"

of humoars, fo relaxed and weakened. as

let lhe ht:ad

of that bone Clip {poDuneoul1y out of its

a((tabulu1IJ

;

lhat il Ihould (eem nn great wooder if lhe lhlgh Ihould be

(ometimcs luxated even while (he patient hes in bed, with–

OUt any external violc:nce, fo that when the-y rife. one leg,

appears looger or Chorter Ihan (he other, and Jeems as if

were unhinged.

BUl lhis ca(e clo.. nOl happen ro ea(y, in robul! adul",.

in Cuch as are more young and tender,

Whenever lhe (aid head of lhe lhigh-bone is lhruR out,

il is al moJl always wholly dl(placed, (o as 'o O1ake a perfed

luxation. The (xaél foundntfs ofthís head, with tbe great

fqrce of the circlImjacent mllrcles, and the narrownets of

t~e

fides of the

aCdllbulum,

will nOI admit 1he bone tO be

diClocated a lude way ooly; for as foon as lhe head of this

bone is thruCl up tO the (dge of the

aClIabulum,

it muU

unavoidably t¡cher lurD quite out, or e1fe fal! bclck again

into its righl place.

The lhigh is uloally luxated four ways ;

up'tvard,

d D'U.'n–

'Wará, bad'Word,

and

/or1JJard ;

but it is mo(l freqllently

diClocated downwards OInd inwards, towards the larRe/ora–

men

in the

}ubiJ:

for berides that lhe canilagioous de–

(toce on the lower part of the

acelaólllutIJ

is nOI fo high as '

lhe refi. the

Iigamenlum rOltlndu1IJ

is found tO give way

more ea(¡ly in lhal ¡y,¡rt

¡h.m

any other : and latlly, the ad–

jaceot mufcles are found lO be weakell in their

rtfifl~nce

t!lis pan, being infllfficient tO ktep the head

thlS bone

fro01 flipping out; :.nd Ihtn there is a certain eminence in

lhis edue of lhe

acelabulum,

which keeps the heAd of lhe

ol/eflu}riJ

froOl falJlOg back agaio ioto its right place :"but

if Ihe head of lhis bone be difplaced oUlwards. il ccnerolly

nips upwards

Ihe: fame tiOle:; it being fcarce poffible bu t

lhe very IIrong m.(cles o( lhe lhigh mul! lhen draw lhe

bone up'Nards, and lhen there is no eminence there, in

II~e

edJ!e of the

acelabulu1IJ,

to rc:fi(t the head o( the bone

'111

lh¡'l palfage i bUl fhould il al any lime be luxated by ao ex- '

ternall