SECT. CXIX.—ON DISLOCATION AT THE KNEE.
The knee is dislocated in three ways: inwards, outwards, and towards the ham; for it is prevented by the patella from being dislocated forwards. Using, then, the same modes of extension, sometimes by the hands alone, and sometimes by cords, we must have recourse to suitable bandages, and the other suitable treatment, the part being in particular preserved free from motion.
Commentary. Hippocrates, like our author, mentions three directions in which the bones of the knee-joint may be dislocated: namely, inwards, outwards, and backwards. He has not noticed the dislocation forwards, which is, in fact, a very rare case. Celsus mentions, however, that Meges had related a case of dislocation forwards, which was successfully treated by him. But most of the other authorities, he says, have denied the possibility of such an occurrence. He directs the surgeon to reduce dislocations at the knee upon general principles, by making extension and counter-extension. Hippocrates represents dislocations at the knee as being of more frequent occurrence, but less dangerous, than those of the elbow.
Oribasius, like our author, treats only of three kinds of dislocation at the knee. Albucasis denies the possibility of a dislocation forwards. He directs the surgeon, in making reduction, to turn his back to the patient, and take the limb out between his knees; then while an assistant makes extension at the foot, he is to replace the bones with his hands. This seems a very proper method of reduction.
Avicenna likewise mentions only three modes of dislocation. He has described dislocation of the patella, a case omitted by our author. He directs us after making reduction, to fill the hollows with compresses, and then to apply splints and bandages. He says that the knee is often dislocated in walking. He must surely allude to a species of sub-luxation first well described by the late Mr. Hey, of Leeds; for a complete luxation is a very rare occurrence, and is never occasioned but by great violence.
Haly Abbas and Rhases describe only three kinds of dislocation at the knee, and deny the possibility of a dislocation forwards. Both evidently copy from our author.
The earlier modern surgeons, as usual, adopt the views of the Arabians, and accordingly deny the possibility of a dislocation forwards. See Theodoricus (ii, 52.) They would appear to have been wholly unacquainted with the works of Celsus, and to have derived all their information from the Arabians.
Dislocations at the knee-joint are now found to be of much rarer occurrence than they are represented to be by the ancient authorities. In fact only a very few cases have been reported in modern times. We would beg, therefore, to refer our readers to a case related in the ‘Medical Gazette,’ Dec. 16, 1842, by the author of this Commentary. It is necessary to remark, however, that several typographical mistakes occur in the Report, which are partly corrected in a subsequent number of the same periodical.