Fig. 64.—Reducing dislocation of the elbow round the knee.
When the radius only is displaced, the body should be fixed by a jack towel carried under the armpit of the injured side, and over the shoulder of the sound side. A wetted bandage is rolled round the forearm, and a second towel is attached by a clove-hitch (see fig. 62, page [99]) to the wrist for extension, which is made in the axis of the limb until the radius can be slipped into its place on the outer condyle.
In all dislocations of the elbow, when the bones are returned the limb should be bent to a right angle and put on a lateral angular splint for a week or ten days, after which time it should be worn in a sling a fortnight longer.
Fig. 65.—Handle for obtaining grasp of the thumb in dislocation.
The Thumb and Fingers.—When the first phalanx is dislocated from the head of the metacarpal bone it is sometimes very difficult of reduction. The most effectual mode is steady extension, which is procured by fastening the thumb to a piece of wood, which serves as a handle to give command of the phalanx, and is contrived as follows: the thumb is first bandaged with a narrow wetted roller over the two phalanges, and a thick layer of cotton wool is rolled round it; a piece of stiff wood, 1 inch wide, ½ inch thick, and 12 long, is perforated at one end with three pairs of holes ½ inch distant from each other and from the end; through these, three stout tapes, ½ inch wide and 2 feet long, are threaded, leaving three loops on one side of the piece of wood (fig. 65). The wood is then applied to the palmar aspect of the phalanges, the loops passed over the thumb, their ends drawn tight, and tied, not in a bow as the figure represents, but wound round the end of the stick. The stick thus attached becomes a good handle for extending the digit, and also a long lever for altering the direction of the phalanx if desired. Langenbeck of Berlin employs a pair of forceps to seize the thumb, instead of the wooden handle just described. But with the greatest care and perseverance it is sometimes impossible to replace the bone unless the constricting bands be divided with a tenotome.
Hip-joint.—There are three chief directions in which the hip is dislocated. First backwards on the dorsum ilii, or further on to the sciatic notch. In this dislocation the limb is shortened, moved with difficulty, drawn inwards over the other, and its great toe touches some part of the back of the other foot. The hip itself is altered, the great trochanter being nearer to the crista ilii, and more prominent than on the uninjured side, and the head is often plainly felt in its new position. Resistance to extension of the limb, limited movement of the hip, with rotation inwards, are the distinguishing points between this dislocation and fracture at the neck of the femur.
Treatment.—Apparatus.—A complete apparatus for this purpose is contrived and sold by instrument makers, but a sufficiently serviceable one can be extemporised when the former is not at hand; it consists of:—
1. A rope running in two pulley blocks.