1000000031

67 3

l ernal fIolTCC,

there muO ccrtainly be

rupture of

the round

ligamento

When fhe thigh is Jiflocí\ted

forwards

and downwards,

which is

\','Illl

cfualJy happens, (be: Jeg hangs firaddJing

0\:1[–

ward, and is lcmzcr

th:m lhe

ot:le"T j

airo

die

knee aud foot

t urn olH ....'an:s ;

the hcad

(he bone

¡t(elf

will he

fclr

near

l he

lo\*er

p:tl't

oí rhe

iJJguen

and "o/

pubiJ:

rometi~es

fli ere

í\

(upprclTi."n of urine in

lhis

cafe; when fome

nuve,

which

commlllli:a.cs

Wilh the 61adder, is vioJendy compref.

fed; in lhe buttock may

perceived a cavity, {rom

che

/ r ochflnler

II//tjiJr

and (be

rc~

of Ihe bone

bci~g

difplaced ;

~nd

the thigh. booe. be not timely replaced ioto its

ocel o –

loU/UIII ,

lhe

\Vhole

J im~

withers

filordy

~ftnwards

;

and

this

is lhe: Tc'cfon why

lhe

p;uicnt

eJO

bear liHle

or 00

ll:refs up·

thH limb, but mufl altvays incline and throw Ihe weight

eLhis hody upon the other .

BUI if Ihe thigh .bone be d¡fplaced backward, il i. ufually

drawn upward airo at the [ame time: hence m ere will

perceiv.::d a cavity behind lhe

ingUtll;

but upon the h:ulnch

(\r bultock. a tumour; becaufe the

h("ad

and

trocholl/er

chis bone

will

be thruít there. The tumour in the hau"och

being th ruHupYlards, the rell

the limb will become lhorter

th~n

th e olher, and the fOOl will [cem

[UrR inwards

lhe

hecl will not toueh the ground, and fa ,he perfoD will f«m

tO Cland upon his ' oes ; and laaly, the luxated limb may be

bent wilh more eafe tha.n exteoded.

VVe do ¡lOt withou, reafon judge Ihe ,high to be luxaled ,

(l .)

"{hen \Ve find the ligamen" of ,he bone have been re·

laxed by fome precediog congellion of humours, and wllen

no external violence has beeo exerud upon ¡t, efpecially in

young patien" .

(2.)

When oei,her ,he fymp,oms, pain,

t umollr, or inft.mmatioo follow: aod 1. 00y, (3.) When

the whole- limi> may be bent and turned abat1t at the

Dcda·

i ulum

without ar.y crufhing of the bones, which is otber·

wire corumon in

fr~étures .

The contrary of chefe ligns are

flrong indicatioos that

¡,¡

fraélure

prerent j more panicu–

Jarty if the foot in grown perfon5 be fhoner, from [he

in·

jury of any ex,ernal violeote, aod you hear a grating of Ihe

bones in moving the limb.

The 11Ixa,ed booe is always to be replated in a me,hod

agreeable to the nature and direélion of the d¡{location.

\ Vhcn it is difplaccd forw.utls and do\'.'nwards, the patient is

to be laid fiat upon his back

t:able; then a Jincn napkin

or llrong

l1iog is

tO be made

faU Qvcr

the groio about the

pan

afF~éled,

fo that one end of the Oing may come over the

bell

y. and tbe other over the

na/u

and

b~ck,

to be both tíed

together

in a

knol upon the fpi De of the

(JI

iliuTn,

and after–

wards fa ilened·

a hao" 6xed in fome

po~

or held

r.rm

by fome . lIillants; ra,her ,he r.rll, if we ufe ,he polyfpallon

pullcy, tO retaio the patient's body 6rm from giving way

in lhe extenuon; iD like manner, at tlie bottom of the thigh,

Hule above the knee, there mufi be alfo fancnt d another

napkint or

ílin~.

Wilh

comprcfs betwcen

,it

and the thigh.

Hoth the Clings being drawn tight, the thigh is

be ex tend–

ed, not vehemently, bUI only fo much as is fufficient to draw

.fhe bone out of

¡es

linus. lhat ít may be replaced into its

ocdo!n'/u1IJ

the furGeon's handsj one hand is tOprefs lhe

head of tbe lhi.eh.bone outward, while lhe othcr conduéls

the knce in",aros

Dr. the reduetioD may be made by nap–

I< ins, falleoed round the extremicies of the thigh like fl ings,

much as io a luxation of lhe humerc.s; which \ViII be more

!¡kcly

[uceced if Ihe knee be a' tbe fame time prclfcd in-

w:lTds by the hands. When \.he rJrc_recitcd Ol<::lnS are not

foll'icicnt to

mo:ke

lhe exrenfio n. it

will

necelfa~y

to m:4ke

ufe of ,he polyfpallon or pullcy. As fcon as ,he 'high i.

found

tú

be lofficiently extendeJ, the fureeao murt take

par·

ticular care to rdlore the 111xated head af [be rhigh_bone

with his hands rroOl [he

puhiJ

into irs former fl!at.

Whencver the thigh

luxated backward, the patient

ís

to be placed fl at po a table, with his tace dowDward; aud

the thlgh is tO be extended in direélly the fame manner. but

liule more rl rongly than we

jufl

now propofed¡

and

the re·

dutlíon is to

effetted af{erwards bythe (urge,on's hanrls.

aflifia nt in [he mean time extending [he Iimb, and turoing

in\V4rdli¡ by this meaas the head of the thigh-booe gene·

rally Oips very readly again iDtll its

acela6u!uJIl.

Of a

L UXAT 'ON

of Ih<

PA TELLA

ami

KMfE,

TIB''''

alJd

FIBULA .

T H'

pala/"

is ufu.lly lu,;>ted mollly

,he inlernal or

externdl í:de of

the

joiot; but whenever the koee is perfett–

Iy luxa'ed, ,he

parella

can !Caree ",oid beiog difplaced at

the Carne time, becaufe of

Hroag conoeBion to the thi,h

and

lihia .

The reduaion of a lUllaled

paulla

is ufually no very great

difliculty, if ,he palien, be laid

ft"

on his back upon a lable

or bed. or if he be bid in (har pofl.ure upon an even floor,

fa as ,ha, ,be leg m.y be pulled ou, fini" by an allillant :

for ,hen ,he furgeon may Grmly gufp Ibe patella wi,h hi.

-nngers, acd afterwards preCs it llrongly into i(s rigbt place;

which may be alfo effeéled if ,he pa,ieol Claod. upright:

when this

done, there remains Dothing

bUl

carefully

bind up ,he difordered

p.rr,

aod ' o le' ,he pa,ien, rd i

q uietly for fome days, fome,imes gently beñding and ex' cod–

iog his leg 'o prenot 'i, from growing fiiff, ,ill tbe pains

are gane

off.

and the limb h;¡,s"recovered íts former ilreogth.

A luxalion of !he knCt i. properly fo, wheo ,he

libia

recedes from under

the fimllr.

The Jeg is Cometimes lux–

ated froro "the bafis

(he thlgh-bone, either on tbe out or

¡nfide, or backwards

íeldom or never forwards, a nleCs it

be forced aod drinn very violenlly ,hat way;

beca.fe

for–

wards, the patd la is bound againH lhe articula.tioD, by the

very Clrong ,endons of ,he Olofdes which eXlend the leg;

nor is i,

e.fy

for ,he bone; of ,he leg 'o be wholly.difplaced

from ,ha, of lhe 'h;gh, fo a. tO

m.ke

perfea luxa,ion;

rearon of the grcat {treogth of

~he

ligamenu, and che tWO

dccp

jilluf<J

which recelve ,he h<ad of Ihe Ihigh-bone.

As Ihis kind of luxOlion is very .afy

difcover from

th~

t\l jo coverin, of lhe j"in t, with the tumors and ca,¡lies

whicb follow;

fo~

when it is diCcovered, it is as difficult

to make

perfeél cure [hereof, without leuing the boces

join together ; or leavi ng fome l1:iff'nc(s in the knee ; whicb

fi rll acciden, is u¡"U¡lIy c.!led

anch)"I,¡i, .

When the knee

but

Olgbdy

luxated . lhe p:uient is to

be fe.,ed on a bed, beoeh,

lable, .nd one aAíllanl bold.

the thigh fi rm aboye lhe

knee,

and lhe other eXlends the

let:;

but the furgeon io the mean time rCtlbces the bones by

bis ha.d, .nd n;ngs if

nécelf.ry

, or pufh<s it bj· Ihe ap·

plication of his knce ¡O[O its natural place.

Somelimes Ihe

jihu/a

i5 Ccparated by fome external vio·

lence from the thigh-bone, and jc lhen diHorted either up·

ward or dow"ward : and this genenl!y

happ~ns.

Whr!D

the

fOOl hao¡ peeo luxated outward ; therefore. '7hen this i5 (he

clfe, ' ''<re is nced of e"leoÚoD. T be bono i, to be firl!

rtll"red