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.

    984/1006 (page 800)
    to Kiva) (a) be laid on his back, upon a table covered with a mattress, and between the thighs, covered with a compress, a stout towel drawn, of which both ends must be held by an assistant standing at his head ; a second towel is to be carried round the pelvis, and both ends given to an assistant standing on the uninjured side of the patient ; a third towel is to be placed around the pelvis, between the spines of the hip-bone and the trochanter, carried round the table or bedstead, and tied so as to pre- vent the elevation of the pelvis. The thigh and leg are now bent by an assistant, to relax the flexors, and at the same time abducted, to relieve the stretching of the gluteal muscles, and the knee should be rotated inwards, by which the head of the bone, being set free, resumes its primary direc- tion, whilst the capsular ligament holds it fast above. ‘The head of the bone is guided from its primary direction usually by a slight twist or pull at the knee, or it is lifted up by the Surgeon, standing at the injured side, partly with his hands, partly with a cloth employed as a lever. According to Rust’s (5) plan the patient being fixed as recommended by Kiues, a folded cloth is to be applied around the upper part of the thigh; the thigh drawn down, and at the same time raised by a strong assistant, who grasps it above the knee, which is to be bent, for the purpose of bringing the head nearer the under part of the socket; then it is to be drawn and abducted, upon which, by the action of the muscles, it springs into the socket with an audible noise, without the employment of any considerable ex- tension being requisite. Cotompar (c) proposes a mode of reduction which he has always successfully employed without assistance and without pain to the patient. The patient stands upright upon the undislocated limb, his chest bent forwards and resting on a table or high couch, withs his hands grasping the opposite sides of the table or couch, to keep his body immovable during the operation. The Surgeon places himself behind the patient, on the inside of the dislocated limb, if the dislocation be forwards, but on the outside if it be backwards. He puts first one hand above the tarsus, to bend the leg upon the dislocated thigh ; the other hand, which lies behind the knee, is employed to make gradual pres- sure from above downwards, for the convenience of extending the muscles. With the first hand heimparts to the limb gentle motions from right to left, and from before to behind, in order to overcome the opposition of the muscles of the thigh, and to render the head movable, which then moves from the place in which it is, and enters the socket with a noise. 1078. In the reduction of dislocations of the thigh with pulleys, the following mode is to be pursued. In the dislocation backwards and upwards, the patient should be placed upon a table, anda girth carried between the pubes and upper part of the thigh, outwards and upwards, and fastened to a hook behind the patient. Above the knee should be applied, around the thigh, a linen pad, and over it a leathern strap, from which other straps descend, and are connected with the pulley fastened before the patient. The knee is to be a little bent, but not at a right angle, and directed somewhat obliquely over the other limb. The drawing of the pulley is to be slowly continued, till everything is tight and the patient complains of pain; this degree of extension should be kept up to relax the muscles ; then it is to be repeated till the patient complains, and in this manner continued till the head of the bone comes down. When it comes to the edge of the socket, the same degree of extension must be kept up, and the knee and foot rotated outwards without violence. It is often necessary to carry the arm beneath the thigh, near to the joint, for the purpose of lifting the head of the bone over the socket. In the dislocation, inwards and downwards, the patient is to be put on (a) Stcn, G. R., Dissert de. luxatione femoris. (c) Ueber die Merotropie bei den Luxationen Berol., 1823, p. 26. des Hiiftgelenkes ; in Fror1£Ep’s Notizen, Sept. 1830. (b) Ricurer, above cited, p. 706. (d) AstLEY Cooper, above cited, pl. viii. fig. 1.