Posterior dislocation of head of femur. (Lejars.)
This classification into the anterior and posterior seems to the writer to simplify the general subject and to be serviceable for its particular purpose and place. Inasmuch as anesthesia is nearly always required for these injuries it may be expected to clear up difficulties in diagnosis by its aid.
Treatment.
—Through the anatomical researches of the surgeons above named, as well as those of Allis and others, the method of reduction of hip dislocations is practically always that by manipulation, and is in nearly every instance commenced with flexion. In fact a considerable number of backward dislocations can be reduced almost alone by flexion and rotation with traction, the patient being upon his back, preferably upon the floor, and the surgeon standing over him. While anesthesia is not necessary in all cases it affords sufficient assistance to justify its general employment.
In the backward dislocations, the patient and surgeon being in position as above, it is well to employ the Kocher method, which consists of (1) inward rotation, by which the capsule is relaxed and the head of the bone carried from the pelvic surface; (2) flexion to a right angle, preserving the existing adduction and inward rotation; (3) traction, by which the capsule is made tense and the head of the bone raised to the level of the socket; (4) outward rotation, by which the posterior part of the capsule and the outer band of the Y-ligament are tightened and the head turned forward into the socket.
Fig. 359
Fig. 360
Fig. 361