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
Catalogue details

Licence: Public Domain Mark

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

    949/1006 (page 765)
    987. The prognosis of dislocation depends on its complication, seat duration and cause. Simple dislocation may usually, by early assistance be reduced, and in general is not dangerous ; compound dislocation is, however, on the contrary, frequently accompanied with very dangerous symptoms, and according to the degree of bruising and tearing of the soft parts, according to the constitution of the patient and the like, it is often as necessary, as in compound fracture of bones, to determine at once on the necessity for amputation, or the possibility of preserving the limb. Dis- locations in ball- and socket-joints are commonly less dangerous than in hinge-joints, although they are more difficult to reduce. In joints sur- rounded with strong muscles and ligaments, severe symptoms mostly occur. The earlier the reduction of a dislocation is attempted, the more easily is it effected (1); this, however, must often be delayed, on account of the already existing great inflammation and swelling, though not too long, as the dislocated bone is always to be considered as the principal cause of these symptoms (2). In dislocations depending on palsy of the muscles and laxity of the ligaments, the reduction is easy, but its recurrence on the slightest violence is to be feared. In powerful or in old persons the re- duction is more difficult than in young and weakly persons. From pres- sure of the head of the bone upon the nerves and vessels severe symptoms often occur ; there may be either partial or complete palsy, or stiffness of the joint, and anchylosis may remain as consequence of inflammation. [(1) My friend, Lisron, tells me, that he once reduced, without assistance, a dislo- cation on the back of the hip-bone, two or three minutes after it had occurred, by the person having been thrown from his horse, simply by putting his hand on the pelvis and pulling and rotating the thigh with the other. This is probably an unexampled case, but it proves, that the earlier the reduction is attempted the less power have the muscles to offer resistance. (2) The necessity for delay in the reduction of dislocation on account of the accom- panying inflammation must be extremely rare, unless violent and unwarrantable efforts have been previously made without success. One such instance I have known, in which suppuration of the shoulder-joint ensued and the patient died, without the dislocation being reduced. But as a general rule, dislocations should be always reduced, and with the employment of moderate force there is little if any attendant danger.—J. F. 8. ] 988. The cure of dislocation requires, the reduction of the dislocated head of the bone, the fixing it in its socket, and the removal of the symptoms. 989. The reduction of the dislocated head of the bone into its socket ( Repositio, Lat.; Einrichtung, Germ.; Reduction, Fr.) is to be attempted by extension and counter-extension, and by pressure on the head of the bone itself, which thrusts it into its socket. The object of the extension and counter-extension is to counteract and lengthen the contracted muscles; therefore many recommend that the extension and counter-extension should not be made at the extremities of the dislocated bones, so that there should not be any circular compression of the muscles of the limb by which they may be excited to more violent con- traction. This notion, however, is rejected by Catiisen, A. Coorer, and other Surgeons. In certain dislocations, for instance those of the elbow-joint, the extension and counter-extension can only be effected on the dislocated bones themselves. The extension must always be made in and with gradually increasing force, so as to tire the muscles ; the posi- tion of the limb must specially be such as renders the muscles as lax as possible (a). (a) Loprx’s Journal, vol. iii. pl. ix. f. i.