Leather Splint for the Hip.—This joint is by far the most difficult to fit. The hip splint should obtain a good grasp of its fixed point, the pelvis, and a stiff bearing on the front of the thigh where its pressure is to be exerted. There are many plans of procuring a satisfactory fit; the following is one of the best.
First cut a pattern on a sheet of paper from which to shape the leather. If possible the patient should stand while the pattern is fitting. Take a sheet of paper large enough to reach round the body, and long enough to extend from the waist to the leg below the knee. Lay it against the diseased hip, carry its vertical margin a little beyond the middle line in front towards the sound side, and the other part round the body behind, till the front is reached on the sound side. Feel for the anterior iliac spine, and mark with a pencil the point midway between it and the pubis; from this draw one horizontal line inwards to the border of the paper, and a second obliquely to the perinæum. Then seek for the junction of the sacrum and iliac bone behind, which corresponds pretty nearly to the point first found in front; from this mark the gluteal fold. Next carry a line vertically from the upper border of the sheet of paper to the great trochanter; and lastly, mark the level of the pelvis. Lay the sheet on a table and slit it with scissors along the lines marked, apply it a second time to the body and bend the thigh part round the thigh, making its anterior margin reach well to the inside of the limb, while the posterior part should almost meet it from behind. The splint should also reach downwards to the back of the knee. The paper is then trimmed down to these dimensions. The hip part is next trimmed so that it clears the buttock on the sound side and passes round to the anterior iliac spine of that side. The pattern being complete, cut a piece of sole-leather to correspond, arranging that the hair or short side of the leather will lie next the skin; bevel off the outer edge all round, and soak the leather till thoroughly soft in water, wipe it dry, and bandage it carefully first to the trunk and next to the thigh. When it is set, superfluous and overlapping edges must be marked before removal; lastly, the sides of the vertical notch, between the hip and trochanter, are stitched together, and the splint is covered with wash-leather.
Fig. 59.—Leather splint for the hip.
When extension of the hip is required (see page [80]), it can be applied to the leg below the splint without lessening the support that affords.
The accompanying figure, 59, is drawn from a splint fitted by Mr. Heather Bigg on the plan just described.
Gutta-Percha may always be substituted for leather in these splints, and the same plan of fitting is used, except that the notching requisite in leather is not necessary in using gutta-percha; for the directions to use this material see page [50].
CHAPTER IV.
DISLOCATIONS.
The main obstacles in reducing dislocations are entanglement together of the displaced bones and contraction of the muscles; the entanglement of the bones determines the direction in which extension must be made, and also of the counter extension, or point at which the body is fixed to resist the traction practised on the limb; this should be exactly opposite the direction in which the limb will be drawn. The muscles can always be relaxed by chloroform, hence it is better when they are powerful, not to use the limb as a lever to prize the head of the bone into its place. Steady extension instead is better, to disengage the bone from the parts against which it is caught, and to bring it opposite its socket, into which the hands of the surgeon guide it with less risk of laceration of the soft parts than attends forcible leverage.
Lower Jaw.—This bone is dislocated on one or both sides; when the condyle has slipped forward from the glenoid fossa, the contracted temporal muscle keeps the bone from regaining its proper position, and causes the coronoid process to hitch against the malar bone.