In dislocation backward of the forearm, the tip of the elbow is
observed to be farther back, in relation to the two bony prominences
at the side of the joint, than is the case in the sound elbow. This is
best ascertained by touching the three points on the patient's elbow
of each arm in turn with the thumb and middle finger on each of the
prominences on the side of the joint, while the forefinger is placed
on the tip of the elbow. The lower end of the bone of the upper arm
is often seen and felt very easily just above the bend of the elbow in
front, as it is thrown forward (see Fig. 32, p. 126).
Fracture of the lower part of the bone of the arm above the elbow
joint may present much the same appearance as the dislocation we are
describing, but then the whole elbow is displaced backward, and the
relation of the three points described above is the same in the
injured as in the uninjured arm. Moreover in fracture the deformity,
when relieved, will immediately recur when the arm is released, as
there is nothing to hold the bones in place; but in dislocation, after
the bones are replaced in their normal position, the deformity will
not reappear.
=Treatment.=--The treatment for dislocation consists in bending the
forearm backward to a straight line, or even a little more, and then
while an assistant holds firmly the arm above the elbow, the forearm
should be grasped below the elbow and pulled with great force away
from the assistant and, while exerting this traction, the elbow is
suddenly bent forward to a right angle, when the bones should slip
into place.
The after treatment is much the same as for most fractures of the
elbow. The arm is retained in a well-padded right-angled tin splint
which is applied with three strips of surgeon's plaster and bandage to
the front of the arm and forearm (see Fig. 33) for two or three weeks.
The splint should be removed every few days, and the elbow joint
should be moved to and fro gently to prevent stiffness, and the
splint then reapplied.
=DISLOCATION OF THE HIP.=--This occurs more commonly in males from
fifteen to forty-five years of age, and is due to external violence.
In the more ordinary form of hip dislocation the patient stands on the
sound leg with the body bent forward, the injured leg being greatly
shortened, with the toes turned inward so much that the foot of the
injured limb crosses over the instep of the sound foot. The injured
limb cannot be moved outward and but slightly inward, yet may be bent
forward. Walking is impossible. Pain and deformity of the hip joint
are evident.
The only condition with which this would be likely to be confused is a
fracture of bone in the region of the hip. Fracture of the hip is
common in old people, but not in youth or middle adult life. In
fracture there is usually not enough shortening to be perceived with
the eye; the toes are more often turned out, and the patient can often
bear some weight on the limb and even walk.
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