Licence: Public Domain Mark
Credit: A treatise on dislocations / by Lewis A. Stimson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![internal hemorrhage; but the source of the bleeding, whether from an arterial branch, the main artery, or the vein, may remain in doubt, for the radial pulse may persist even Avhen the hemorrhage comes directly from the axillary artery. The subject will be more fully discussed in Chapter VIII. In a case observed by Korte,' this complication accompanied a disloca- tion of the shoulder caused by a blow received upon its upper surface while the arm was abducted; the dislocation was spontaneously reduced before the arrival of the surgeon, and probably the displacement was only slight. An aneurism formed, and was opened under the impression that it was an enlarged lymphatic gland. The autopsy indicated that the lesion was avulsion of the anterior circumflex artery at its origin, and showed also that the inner and middle coats of the axillary artery were torn transversely at a higher point, but the calibre of the vessel was not thereby obstructed. A somewhat similar case was reported by Despres,^ in which the patient's arm had been violently twisted in different directions. Although a dislocation had not been suspected, the autopsy (death having followed gangrene of the arm in the ninth week) showed a rent in the capsule on its inner and anterior side, and the joint was filled with blood-clots, so that it is probable a dislocation had occurred. The axillary artery was intact, but the common trunk of the circumflex arteries had been torn off at its origin. These two cases illustrate one variety of the complication at the shoulder and the mechanism by which it is produced. Of another, damage to the wall of the axillary artery by over-stretching, the following may serve as an example, although it is possible that the injury was pro- duced during reduction. Nelaton'* refers to a case under the care of Berard, a subcoracoid dislocation of the humerus, in which the axillary artery was torn completely across through its inner and middle coats, and the outer coat was elongated like a glass tube drawn out in a flame. The lesion was followed by gangrene of several fingers, and, finally, by the death of the patient. He speaks, also, in two places* of what appears to have been a single case of similar character under his own care ; the two inner coats of the axillary artery Avere torn to a very limited extent, and an aneurism formed, for which he tied the subclavian artery three months later, with a fatal result. The following cases illustrate other varieties : Mr. J. W. Turner'^ reported two cases of rupture of the popliteal artery complicating dislocation of the knee. In the first a man, twenty-four years old, fell from a height of thirty feet and sustained a compound dis- location of the knee, the condyles of the femur projecting through the integument of the ham. The limb Avas immediately amputated, and the two inner coats of the popliteal artery were found to be ruptured, the outer coat remaining untorn. 1 Korte: Archiv fiir klini^clle Chirin\'ic^, 1882, p. Gofi. 2 Despres : Bulletin de la Societe de Chinirgie, 1878, p. 116 ' Nelaton : Pathologie Extevne, 1ft od., vol. ii. p. 368. < Lcc cit., ]>p. 302 and 3(''8. * Turner: Trans. Edinbiiri;h Med -Cliir. Soc, vol. ill. p. 308.](https://iiif.wellcomecollection.org/image/b21987063_0042.jp2/full/800%2C/0/default.jpg)
