The philosophy of manipulation in the reduction of hip and shoulder dislocations : read before the American Surgical Association, 1884 / by Moses Gunn.

  • Gunn, Moses, 1822-1887.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: The philosophy of manipulation in the reduction of hip and shoulder dislocations : read before the American Surgical Association, 1884 / by Moses Gunn. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    These figures—as is the case in all my illustrations—are made from a dissection of the parts, which dissection I also herewith exhibit. It is seen that the anterior and inferior portion of the ligamentous capsule is untorn, tense, and holds the dislocated head firmly hooked outside the dorsal portion of the rim of the acetabulum, while that portion of the capsule between the anteri- or inferior spinous process of the ilium and the anterior inter- trochanteric line of the femur, which is reinforced and strength- ened by the ilio-femoral fibers, is quite loose, owing to the aprox- imation of these two points, in the shortened, adducted, and in- ternally rotated state of the limb which characterizes this form of dislocation. Thus, this ilio-femoral portion of the capsule, in the dorsal luxation, is entirely without influence, either in deter- mining the deformity or in opposing our efforts at reduction. It is entirely to the anterior and inferior portion of the capsule that these influences are due. If we now flex, adduct, and inwardly rotate to a still greater degree, we shall loosen the anterior and inferior tense untorn portion which is holding the head hooked outside the acetabular ridge, and then by a moderate amount of force we may draw the head into the socket. This is most conveniently accomplished by putting the patient on the floor on his back ; an assistant fixes the pelvis; the surgeon grasps the limb, flexes and adducts it till it crosses the limb of the opposite side at a point as high as the union of the upper with the lower two-thirds of the femur ; now rotating the limb inwardly, he will be able to lift the head into place by a moderate effort. The backward dislocation of the hip. In this variety, whether produced by force operating on the great trochanter rotating the femur forcibly inwards, or by force applied to the lower end of the bone while it is flexed to a right angle with the trunk, it is evident that the posterior portion of the capsular ligament is ruptured, and it is nearly as certain that the anterior portion remains untorn. This anterior unruptured half is drawn tensely across the acetabulum and holds the head hooked behind the posterior portion of the acetabular wall. This is shown in Fig. 3.