Volume 1

A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South.

Maximilian Joseph von Chelius

Date:: 1847

Credit: A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South. Source: Wellcome Collection.

947/1006 (page 763)

$into congenital, (Luxationes congenite,) and acquired (Luzxationes ac- quisite.) : (1) Distortion has various degrees, according as the fibrous tissue, the synovial mem- branes, the vessels and nerves severally, or altogether, are severely stretched or torn through :—1st degree, Slight pain and gradual swelling of the soft parts; 2nd degree, Sudden and severe pain, swelling, and effusion of blood ; and therewith, in 3rd degree ‘Unnatural motion of the joint in all directions. 984. The diagnosis-of dislocations depends on the disturbed function of the dislocated limb, and on the appearances produced by the bone when removed out of its socket. The most remarkable signs are, entire or partial loss of motion of the limb, with altered form and position; it may be shortened or lengthened according as the head of the bone is displaced in this or that direction, or it may be distorted, which depends on the contraction of the muscles, that, by the dislocation of the head of the bone, are most commonly torn and extended, hence rotation of the limb occurs on the opposite side to that on which the head of the bone is dislocated ; the natural form of the joint is changed, the socket is empty, and the dis- located head forms an unnatural projection ; the limb is fixed in its position by the stretched muscles, and can only with the greatest pain be moved, and often not at all. ‘To these symptoms are added severe inflammation, pain, swelling, and effusion of blood in the neighbourhood of the joint. The determination of the dislocation is therefore more or less difficult, according to the superficial or deep situation of the joint, according to the nature of the dislocation and the degree of the accompanying swelling. A more remote effect of dislocation is a kind of crackling which depends on the effusion of plastic lymph into the joint and into the mucous bags, and may easily mislead to the presumption of fracture. [The limb is not always at once immovably fixed after dislocation, even when at the hip-joint. I had a case of dislocation into the ischiatic notch several years since, and when I saw the man six or eight hours after the accident, there was so considerable motion of the thigh, which could be bent quite up to the belly, that I doubted the nature of the accident. On the following morning, however, the limb could not be bent upon the belly, and the other symptoms of dislocation being present, I made use of the neces- sary means and replaced the bone. I have also seen other examples of the same kind. Sometimes if a patient be not seen for some hours after a dislocation, it is impossible to ascertain the nature of the accident, on account of the great swelling. The Surgeon should therefore be especially cautious to make further examination on the subsidence of the swelling, so that the patient may not suffer from his negligence.—J. F. S.] 985. The occasional causes of dislocation are external violence or vio- lent contraction of muscles: The former either acts directly on the joint or on the end of the bone opposite, in which case the dislocation is effected more easily ; and generally the bone is obliquely situated in reference to its socket, at the moment when the external violence acts. Dislocation specially occurs the more readily, as the parts about the joint and the muscles are lax and the motions of the joint not confined (1). For the latter reason dislocation of the upper arm is more frequent than that of the thigh ; and dislocations of the hinge joints and of such as have broad opposing surfaces to their bones, in which the motion is restricted, are mostly incomplete. Old persons are more rarely subject to dislocation, because the heads of the bones are brittle and easily break ; young persons also are rarely subject to dislocation, because their epiphyses easily break (2) ; _ in persons of middle age dislocation is most common (3). [(1) Dislocations sometimes happen by mere muscular exertion, some accidental dis- position of the bone occurring, by which the ordinary antagonism of the muscles is .. disturbed, and the efforts of one set become too great for the other. It is in this way$