depends on its form, but, as a rule, early movement is advisable. But
when by the formation of the bones a joint is weak, as at the outer
end of the collar-bone, and at the elbow-end of the radius, prolonged
rest for the joint is necessary or dislocation may recur.
_Congenital Dislocation at the Hip._--Possibly as a result of faulty
position of the subject during intra-uterine life, the head of the
thigh-bone leaves, or fails throughout to occupy, its normal situation
on the haunch-bone. The defect, which is a very serious one, is
probably not discovered until the child begins to walk, when its
peculiar rolling gait attracts attention. The want of fixation at the
joint permits of the surgeon thrusting up the thigh-bone, or drawing
it down in a painless, characteristic manner.
The first thing to be done is to find out by means of the X-rays
whether a socket exists into which, under an anaesthetic, the surgeon
may fortunately be enabled to lodge the end of the thigh-bone. If this
offers no prospect of success, there are three courses open: First,
to try under an anaesthetic to manipulate the limb until the head of
the thigh-bone rests as nearly as possible in its normal position, and
then to endeavour to fix it there by splints, weights and bandaging
until a new joint is formed; second, to cut down upon the site of the
joint, to scoop out a new socket in the haunch-bone, and thrust the
end of the thigh-bone into it, keeping it fixed there as just
described; and third, to allow the child to run about as it pleases,
merely raising the sole of the foot of the short leg by a thick boot,
so as to keep the lower part of the trunk fairly level, lest secondary
curvature of the spine ensue. The first and second methods demand many
months of careful treatment in bed. The ultimate result of the second
is so often disappointing that the surgeon now rarely advises its
adoption. But, if under an anaesthetic, as the result of skilful
manipulation the head of the thigh-bone can be made to enter a more or
less rudimentary socket, the case is worth all the time, care and
attention bestowed upon it. Sometimes the results of prolonged
treatment are so good that the child eventually is able to walk with
scarce a limp. But a vigorous attempt at placing the head of the bone
in its proper position should be made in every case. (E. O.*)
JOINTS, in engineering, may be classed either (a) according to their
material, as in stone or brick, wood or metal; or (b) according to their
object, to prevent leakage of air, steam or water, or to transmit force,
which may be thrust, pull or shear; or (c) according as they are
stationary or moving ("working" in technical language). Many joints,
like those of ship-plates and boiler-plates, have simultaneously to
fulfil both objects mentioned under (b).
Public-domain text, read in full here on John Shaqi.
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