The wrist and ancle are complicated joints, and thence capable of a great number of motions, and subject to a variety of sprainings, but not a perfect dislocation; nevertheless, they are very painful, and sometimes tedious in getting well. Whatever be the matter, the sick part should be compared with the sound, and the difference is soon seen.
If it so happens, that there appears a perceivable difference, the parts should be gently extended, and reduced; and all that is to be done, is the securing it well with a bandage, and fomenting it with Spirits of Wine and Camphor, (A) or, what is yet better, Linament of Soap. (B)
The thumb, however, is liable to be dislocated, which is easily perceived; which should be immediately reduced, and secured with a bandage, and treated as already directed.
Dislocation of the Thigh Bone.
The articulation of the thigh bone with the hip is similar to the shoulder, with regard to the head of the bone, and the pan in which it moves, except that it is much deeper. It must be a great force that drives it out of its articulation, and consequently very difficult to be reduced. It may either be dislocated inwards, or backwards.
If the dislocation is inwards, which is the most common, the toes will be turned outwards, and the whole leg and thigh will be somewhat shorter than the other; so likewise, if it is dislocated backwards, the leg and thigh will appear shorter, but the toes will be bent inwards. The best way of determining, as I have said before, is to make a just comparison of the sick and sound leg.
The reduction is somewhat difficult, and will sometimes baffle the most experienced surgeon, because the acting muscles are very strong; and when they have first begun to contract the parts, they will not easily suffer themselves to be relaxed. Nevertheless, lay the patient upon his back or on the sick side, upon a steady table; let an assistant hold him fast, another extend the thigh, so as to have the knee bent; the operator having a napkin resting on his neck, and under the thigh of the patient, similar to the method directed before by the shoulder; and then with both hands bend the thigh, as with a lever, into its socket again; when it will give a loud snap, coming into its proper place.
It very frequently happens in this heavy dislocation, that either the articulation is not reduced, or that it immediately slips out again when reduced; so that the patient will never recover the former use of that limb more. In this case nature is very kind, and the part where the bone slips into will become callous, and form as it were a new acetabulum; by which the patient in time comes to walk, though (as it may be supposed) but lamely. In the course of my practice I have met with but two perfect dislocations of the thigh, both of them perfectly recovered; but it must be remembered, they had youth on their side, and the greatest care joined to favourable circumstances.
At best however, it is an ugly accident, for it is not only that the ligaments that surround the joint are generally torn, but very often the thigh bone is fractured at the same time. It requires more skill than one would suppose, to determine which is the case, whether a fracture, dislocation, or both; and am apt to believe they are often confounded with each other.
When the dislocation is reduced it should be well secured with a long double-headed bandage; the patient kept still, the part well fomented, and if requisite, some blood taken away: a fever generally attends, which should be duely taken care of.