Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
In the _backward_ varieties (dorsal and sciatic) the [inverted
Y]-ligament is relaxed by flexing the thigh upon the pelvis in the
position of adduction. The thigh is then fully abducted, to cause the
head of the bone to retrace its steps forwards towards the rent in the
capsule; and at the same time rotated laterally to relax the rotator
muscles. This combined movement tends also to open up the rent in the
capsule. Finally, the limb is quickly extended to cause the head to
enter the socket. This object is often aided by making vertical
traction or lifting movements on the abducted and laterally rotated
limb before extending.
For the reduction of the _forward_ varieties (obturator and pubic),
the thigh is first fully flexed on the pelvis, but in the abducted
position. The limb is then strongly rotated medially and abducted, and
finally extended. Lifting movements may be found useful in these cases
also.
All methods of reduction by forcible traction on the extended limb are
to be avoided, as they fail to meet the primary indication of relaxing
the [inverted Y]-ligament.
After reduction, the limb is steadied by sand-bags; massage is carried
out from the first, and movement after a few days. The range of
movement is gradually increased, and the patient is allowed to use the
limb with caution in from two to three weeks.
When the rim of the acetabulum has been fractured, the patient must be
confined to bed with extension for six to eight weeks, to avoid the
risk of re-dislocation.
Changes of the nature of chronic arthritis are liable to occur in and
around the joint in old and rheumatic subjects; and atrophy or
paralysis of muscles may follow, if their nerves are implicated.
#Old-standing Dislocation.#--It is impossible to lay down any
time-limit for attempting reduction in old-standing dislocations of
the hip. Manipulation may succeed in cases of some months' standing,
and may fail when the bone has been out only a few weeks. In certain
cases, even after reduction has been effected, there is a marked
tendency to re-displacement. In any case, the attempt does good by
breaking down adhesions, provided no undue force is employed such as
may damage the sciatic nerve or vessels, or fracture the neck of the
femur, and success may attend on a second or even a third attempt at
intervals of from three to five days. If manipulation fails, and if
the deformity is great and the usefulness of the limb seriously
impaired, an attempt may be made to effect reduction by operation; the
operation, however, is one of considerable difficulty, and in the
event of failure the head of the bone should be excised. If the head
has formed a new socket for itself and there is a fairly useful joint,
the condition should be left alone.
_Congenital dislocation of the hip_ is described with Deformities of
the Extremities.
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