[Fractures and dislocations.].

  • Stimson, Lewis Atterbury, 1844-1917.
Date:
1883-88
Catalogue details

Licence: Public Domain Mark

Credit: [Fractures and dislocations.]. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    normal ranges of motion, and if it is great enough ro overcome this resist- ance it is more likely to cause in addition other and perhaps extensive injuries of the soft parts or of the bones. The injury produced in this manner at the ankle is, indeed, classed as a fracture, although the partial or complete displacement of the astragalus, from its relations with the tibia, gives rise to the most prominent features of the injury, and may, if uncorrected, cause great permanent disability. Violence, then, acting in a given manner, may cause a fracture, a dis- location, or a sprain according to its force, the strength of the resistance offered by the ligaments and the bones to which they are attached, and the prolongation of its action. 2. Muscular action. Contraction of the corresponding muscles can cause the dislocation of a sound joint in either of two ways : it can, by rapidly moving the limb, communicate to it a momentum which acts in the same manner as external violence and produces a dislocation when the normal limits of the range of motion are reached and conditions of leverage are established. A case, probably of this kind, was observed by Sedillot:1 a woman, forty-six years old, who dislocated her shoulder by raising her arm to strike a blow. Or, secondly, the muscular contraction acts like external violence received at or near the end of the bone, or transmitted along its longitudinal axis, and draws the bone out of its socket. For this it is essential that one or two muscles should contract violently, while the others that normally act upon the joint remain passive, or that the limb should be in such a position that the line of traction of the muscles makes an acute angle with the opposing articular surface. Instances of this kind are common at some joints; dislocation of the lower jaw is commonly caused by muscular action, in yawning, laughing, vomiting, and others have been caused in like manner at the shoulder and hip, and, very exceptionally, at other joints. As illustrative examples may be mentioned the following: A man sought to draw in through a window a heavy bale of goods suspended from a crane, and as he pulled upon it with his arms raised he felt a painful snap in the shoulder, and was found to have dislocated the humerus into the axilla. Apparently this was effected by the direct traction of the pectoralis major and latissimus dorsi. A man, fifty-one years old, dislocated both shoulders (subcoracoid) by drawing himself up with his hands ; a painter dislocated his shoulder while painting a ceiling; a woman, by trying to lift a heavy object from a shelf; a man. by trying to lift at arm's length a heavy book from the floor; and a woman, by carrying a heavy load upon her head with both arms uplifted. Many cases have been reported in which dislocation has been caused by the convulsive contractions of individuals affected with epilepsy, tetanus, or uraemia, or poisoned with strychnine. In many of the cases reported as such the dislocation may have been caused by violence re- ceived in falling during the fit or bv striking the limb against some object, but in a number of them the history positively establishes the absence of any other cause than the contraction of the muscles. 1 Sedillot: Diet. Encyclopedique, art. Luxations, p. 23.