Backwoods Surgery & Medicine

by Charles Stuart Moody

It will be understood that what I have said touches upon the subject of fractures in only a very general way. The methods of treatment outlined will apply to practically any fracture, and certainly to those most liable to be encountered in the woods.

The four principal dislocations that are liable to engage your attention are those of the hip, knee, elbow, and shoulder. Of these, that of the hip is the most serious. Without going deeply into the classification of hip-joint dislocation, it will be sufficient to say that fortunately by far the greater number of these is where the head of the bone slips out of its socket upward and backward. Those in which the head of the bone occupies other positions with relation to its socket are much more difficult, in fact, for the layman practically impossible.

The signs of a hip-joint dislocation are shortening of the limb, loss of motion, pain, and the turning of the toes in toward the opposite foot. You will be able to distinguish it from a fracture of the thigh by the absence of crepitation (which I have described as the slight grating sound made by the broken ends of the bone rubbing together), and the fact that in a fracture the toes are generally turned out.

A friend of mine once reduced his own hip-joint dislocation in a manner that may prove instructive. He was coming down the steep side of a mountain in winter on skees. Halfway down the hill, while he was traveling at a great rate of speed, he ran into a depression, breaking his skee and dislocating his hip. It was many miles to the nearest cabin, night was coming on, and it was bitterly cold. Death stared him in the face. It was a time for the exercise of judgment if ever in his life.

He crept down to a grove of small pines, selected two that were just a little farther apart than the length of his body, lashed the foot of the injured limb to one with his pack strap, lay at full length on the snow, and clasped the other with his arms. Pulling with all his might, he had the satisfaction of hearing the bone jolt back into its socket. The idea suggested will enable the reader to modify the method to suit each individual case.

In dislocations of the shoulder the old method still in vogue among some medical men is quite easy of accomplishment. Lay the patient on his back and seat yourself at his side, first having removed the shoe from your foot next to his body. Grasp his injured arm and turn it outward from the body. Place your bare foot well up into his armpit. While an assistant steadies his shoulder, pull downward upon his arm, at the same time moving it toward the patient's body.

Make your pull steady, and when you have begun do not relax until you feel the bone jolt into its position. In the case of muscular persons the pull must be kept up for a longer period, or until the contraction of the muscles has been overcome.

Dislocations of the elbow are usually those in which the two lower bones slip backward and the upper bone forward. They may be reduced by grasping the injured arm just above the elbow with your left hand, the fingers just behind the prominence of the dislocation; with the other hand bend the injured arm well forward, at the same time slipping your left hand downward.

When the injured arm is fully bent, grasp tightly with your left hand at the elbow joint and with your right forcibly straighten it. The fingers of your left hand form a fulcrum for the bone that is out of place to act upon and thus force it back into position. This maneuver is somewhat difficult to describe but quite easy to accomplish. One will be surprised with what ease the bone slips back into position.

Dislocations of the knee are reduced similarly, except that it requires two to do the work. Then, too, the knee often becomes dislocated laterally and the pressure must be made in a lateral direction.