Fig. 33.
TREATMENT OF DISLOCATED ELBOW (Scudder).
Note padded right-angled tin splint; also three strips of surgeon's plaster on arm and forearm.
In dislocation backward of the forearm, the tip of the elbow is observed to be farther back, in relation to the two bony prominences at the side of the joint, than is the case in the sound elbow. This is best ascertained by touching the three points on the patient's elbow of each arm in turn with the thumb and middle finger on each of the prominences on the side of the joint, while the forefinger is placed on the tip of the elbow. The lower end of the bone of the upper arm is often seen and felt very easily just above the bend of the elbow in front, as it is thrown forward (see [Fig. 32], p. 126).
Fracture of the lower part of the bone of the arm above the elbow joint may present much the same appearance as the dislocation we are describing, but then the whole elbow is displaced backward, and the relation of the three points described above is the same in the injured as in the uninjured arm. Moreover in fracture the deformity, when relieved, will immediately recur when the arm is released, as there is nothing to hold the bones in place; but in dislocation, after the bones are replaced in their normal position, the deformity will not reappear.
Treatment.—The treatment for dislocation consists in bending the forearm backward to a straight line, or even a little more, and then while an assistant holds firmly the arm above the elbow, the forearm should be grasped below the elbow and pulled with great force away from the assistant and, while exerting this traction, the elbow is suddenly bent forward to a right angle, when the bones should slip into place.
The after treatment is much the same as for most fractures of the elbow. The arm is retained in a well-padded right-angled tin splint which is applied with three strips of surgeon's plaster and bandage to the front of the arm and forearm (see [Fig. 33]) for two or three weeks. The splint should be removed every few days, and the elbow joint should be moved to and fro gently to prevent stiffness, and the splint then reapplied.
DISLOCATION OF THE HIP.—This occurs more commonly in males from fifteen to forty-five years of age, and is due to external violence. In the more ordinary form of hip dislocation the patient stands on the sound leg with the body bent forward, the injured leg being greatly shortened, with the toes turned inward so much that the foot of the injured limb crosses over the instep of the sound foot. The injured limb cannot be moved outward and but slightly inward, yet may be bent forward. Walking is impossible. Pain and deformity of the hip joint are evident.