Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it; by this means the heads of the luxated ribs may slip into their former place.
DISLOCATION OF THE SHOULDER.
The humerus or upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but very seldom directly upwards. From the nature of its articulation, as well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards toward the breast.
The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while another lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient’s arm, and causes it to be tied behind his own neck: by this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, I have generally found it a very easy matter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the extension, the arm ought always to be a little bent.
DISLOCATION OF THE ELBOW.
The bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient’s inability to bend his arm, a dislocation of this joint may easily be known.
Two assistants are generally necessary for reducing a dislocation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck.
Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place.
DISLOCATION OF THE THIGH.
When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; but when it is displaced backward, it is usually pushed upward at the same time, by which means the limb is shortened, and the foot is turned inwards.