The Compleat Surgeon Part 40

When the Elbow is luxated on the inside, the Arm flies out, and the Hand is turn'd outward; but in the Luxation on the outside, the Arm is shortned: If the Luxation be Lateral, a Prominence appears in the Dislocated, and a Cavity in the opposite Part.

To reduce the Internal Luxation, the _Humerus_ and _Cubitus_ are drawn, and at the same time the Surgeon bends the Elbow, by carrying {307} the Hand toward the Shoulder; or else a Tennis-Ball may be laid in the Fold of the Elbow, and the Arm drawn toward the Shoulder.

For the External Luxation, the Extension is to be made, whilst the Surgeon thrusts back the Elbow into its place: Or else a round Stick may be taken, and trimm'd with Linnen-Cloth, with which the Bone is to be push'd back into its place during the Extension. This Stick may be also us'd in the reducing of the Internal Luxation.

For the Lateral Luxations, the Extension may be made in like manner; the Surgeon at the same time thrusting back the Bone into its Natural Situation.

_The Bandage_

Is made with a Band five Ells long, and two Fingers broad, roll'd with one Ball: The Application of it is begun with a Circ.u.mvolution at the lower part of the _Humerus_, it is pa.s.s'd over the Fold of the Arm; a Circ.u.mvolution is also form'd in the upper-part of the Elbow, and the Figure of KY in its Fold. Afterward the Rollers are continu'd upon the Elbow, and the KY's in the inside of the Arm, till the Elbow be entirely cover'd: The Band is likewise carry'd up to the top of the Arm with Rollers, and stay'd round about the Body. The Patient must be oblig'd to keep his Bed, or else his Arm may be put in a Scarf, after the same manner as in the Fracture of the Arm.

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CHAP. XI.

_Of the Luxation of the Wrist._

If the Luxation be Internal, the Hand is turn'd back to the outside, so that for the Reduction thereof, it wou'd be requisite to cause the back of the Hand to be laid upon a Table, and the Extension to be made by drawing the Elbow and Hand, whilst the Surgeon takes care to press the Prominence.

If the Luxation be External, the Hand is bended on the inside; so that to reduce it, the inside of the Hand is to be laid upon a Table, and the Surgeon is to press it after the Extension.

If the Luxation be on the sides, the Hand is turn'd to one side; so that the Extension must be made, and the Hand turn'd on the side opposite to the Luxation. But the Fingers are usually drawn one after another, to the end that the Tendons may be set again in their Place.

The eight Bones of the _Carpus_ may be in like manner dislocated both on the inside and without; and to set 'em right, the Hand is to be laid upon a Table, and the Extension to be made, so as to press the Protuberances on the inside, if the Luxation be internal, and on the outside if it be external. {309}

_The Bandage_

Is prepar'd with a Band six Ells long, and two Fingers broad; so that three Circ.u.mvolutions may be made upon the Luxation; as also divers Rollers in pa.s.sing thro' the inside of the Hand between the Thumb and the Forefinger, and in forming the Figure of KY upon the Thumb, after having made many Rollers upon the Wrist. Two Pieces of Paste-board are also to be laid on the sides of the Wrist, which are bound with the same Band in making Rollers; and the Hand is to be trimm'd with a Linnen-Ball, to keep the Fingers in their mean Situation. Then the Band is to be pa.s.s'd above, to strengthen it, and carry'd up with Rollers along the whole length of the Elbow, to be stay'd below the same Elbow.

CHAP. XII.

_Of the Luxation of the Fingers._

If the Fingers be luxated, it is necessary to make an Extension to reduce 'em, and afterward to use the following

_Bandage._

If the Luxation be in the first Articulation or Joint, the Bandage _Spica_ is to be apply'd, being made of a Band roll'd with one Head, an {310} Ell long, and an Inch broad: It is begun with Circ.u.mvolutions round about the Wrist, and brought over the Luxation in pa.s.sing between the Fingers. These Circ.u.mvolutions are also continu'd to form a _Spica_ upon the Luxation; and the Band is stay'd at the Wrist.

If all the first _Phalanges_ were dislocated, it wou'd be requisite to make as many upon every _Phalanx_, and with the same Band: This sort of Bandage is call'd the _Demi-Gantlet_.

CHAP. XIII.

_Of the Luxation of the Thigh._

The Luxation which most commonly happens in this Part, is the Internal; so that a Protuberance appears on the Hole of the _Os Pubis_; the indispos'd Leg is longer than the other, and the Knee and Foot turn outward; neither can the Thigh be any longer bended, nor drawn near the other.

If the Luxation be External, the Leg becomes shorter than the other, the Knee and Foot turning inward, and the Heel to the outside.

When the Luxation is on the fore-part, a Tumour ariseth in the Groin, so that the Patient cannot draw this Thigh toward the other, nor bend the Leg; his Body resting only upon the Heel.

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If the Luxation be Posterior, a Tumour is felt in the b.u.t.tocks with great Pain, and the Legg is shorter than it ought to be: There also appears a sinking in the Groin, the Leg is lifted off from the Ground, and the hurt Person is apt to fall backward.

To reduce the Internal Luxation, the Patient is to be laid with his Back upon a Table, to which is fixt a thick Wooden Pin, about a Foot long, which is to be set between his Thighs, to detain his Body when his Legs are drawn down; then a Strap is to be pa.s.s'd above the joynt of the Thigh, to draw the _Ischion_ upward; and the Thigh is to be drawn down with another Strap fasten'd above the Knee: In the mean while the Surgeon thrusts the Thigh upward, to cause it to re-enter its Cavity, the Straps being somewhat loosen'd in the time of the Reduction to facilitate the Operation.

To reduce the External Luxation, the Patient is to be laid upon his Belly; and the drawing to be perform'd after the same manner as we have even now shewn, whilst the Thigh is thrust from the outside inward, to cause the bone to re-enter its Cavity.

In reducing the Anterior Luxation, the hurt Person is to be laid upon the side opposite to the Luxation, and Extensions are to be made, by drawing both upward and down-ward, as before: Then the Head of the Bone is to be forc'd, by the means of a Ball thrust strongly with the Knee, in drawing the luxated leg toward the other. {312}

The Posterior Luxation is thus reduc'd; The Patient being laid upon his Belly, the double Extension is to be made, and his Knee drawn outward, to set the Bone in its place. After the Operation hath been perform'd, a Bolster is to be apply'd, steept in Spirituous Medicaments; and the Bandage call'd _Spica_, of which we have given an Account in treating of the Luxation of the Shoulder.

CHAP. XIV.

_Of the Luxation of the Knee._

When the _Tibia_ is luxated behind, its Prominences are in the Cavity of the Ham, and the Leg flies off, or is bended. If the same _Tibia_ be dislocated on the side, a kind of Tumour appears in the luxated side, and a Sinking in the opposite. But if the _Condylus_ of the _Tibia_ remains in the inside, the Leg turns outward; and if it be in the outside, it turns inward.

The Posterior Luxation is reduc'd by obliging the Patient to lie upon his Belly, whilst the Surgeon during the Extensions bends the Leg, in drawing the Heel toward the top of the Thigh.

If the _Tibia_ be luxated on the side, the usual Extensions are to be made, and the Bone is to be push'd with the Knee. {313}

If the Luxation were in the fore-part, it wou'd be requisite to lay the Patient upon his Back, to make the Extensions, by drawing the Thigh and Leg; and to press the protuberant Parts.

_The Bandage_

Is prepar'd with a Band three Ells long, and two Fingers broad, roll'd with two b.a.l.l.s: A Circ.u.mvolution being at first made above the Knee, the Figure KY is form'd underneath, and a Circ.u.mvolution above it; then the Band is carry'd up again over the Knee, in making Rollers and KY's underneath, till the Knee be entirely cover'd.

CHAP. XV.

_Of the Luxation of the _Patella_ or Knee-Pan._