In high displacement of the head of the bone traction should be made in the extended position, by which the head will be brought back of the acetabulum, and then proceed as above.
Of the anterior dislocations the obturator is perhaps the more common, while for its reduction the following directions usually suffice: The limb is flexed toward the perpendicular to disengage the head of the bone, then rotated inward and adducted while the knee is carried to the floor. As Bigelow suggested, in this maneuver we may need the aid of a towel passed around the upper part of the thigh, an assistant making upward and outward traction while the operator is bringing the limb downward. Inward rotation is likely to transform the dislocation into a posterior one. On account of this fact, Kocher would give the following advice: (1) Flex the thigh to a right angle with the pelvis, preserving abduction and outward rotation until (2) traction is made, by which the posterior part of the capsule is tightened and the head brought nearer the socket; then (3) forcible outward rotation is made, which should bring the head upward and backward into place.
A perineal dislocation is usually accompanied by laceration of the capsule. This will permit of easy reduction, which can probably be effected by traction in the axis of the limb in its abnormal position and by direct pressure, with some rotation or rocking.
The pubic and suprapubic dislocations require forcible flexion with traction in the axis of the limb, followed by inward rotation and circumduction of the knee. Some of these maneuvers are illustrated in [Figs. 364] and [365].
So of the other dislocations of the hip; an application of principles similar to the above, coupled with such assistance as may be afforded by manipulation, practised by the operator, or by traction, with the help of an assistant, will usually suffice.
If a general rule could be formulated covering all cases it would be of great assistance. I have been in the habit of quoting a rule of this character, which I first saw mentioned in the American edition of Bryant’s Surgery, edited by Roberts, to the following effect: (1) Flex the leg on the thigh and the thigh on the body; (2) carry the knee as far as it will go in the direction in which it already points; (3) carry the knee to the extreme in the opposite direction and combine this movement with circumduction and traction. In the backward dislocations these manipulations should be accompanied by traction made with one of the operator’s hands in the popliteal space. In the anterior displacement backward pressure instead of traction can be made by pressing upon the knee. I have found this an admirable working direction.
Fig. 364
Reduction of a dorsal dislocation of the hip by traction. (Erichsen.)
Fig. 365