File:Atlas and epitome of traumatic (1902) (14761404674).jpg

Identifier: atlasepitomeoft00helf (find matches)
Title: Atlas and epitome of traumatic
Year: 1902 (1900s)
Authors: Helferich, Heinrich, 1851- (from old catalog)
Subjects:
Publisher: Philadephia and London, W. B. Saunder or company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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lodge on the edge of the acetabulum,and it is evident that abducting the thigh, which a prioriseems a rational procedure, only serves to wedge the headmore firmly in its abnormal position. Thus the advice tobring the thigh into adduction before exerting traction be-comes comprehensible, because this movement permits thehead to glide more easily over the edge of the acetabulum.The manipulations, therefore, consist of traction in a posi-tion of adduction with some inward rotation. If this fails,the surgeon must try what traction in abduction with out-ward rotation will do. During this procedure the head ofthe femur sometimes slips around the outside of the edgeof the acetabulum and becomes lodged in front of thearticulation—so-called circumduction. The position ofthe head cannot therefore always be inferred from the na-ture of the laceration in the capsule, in view of the possi-bility of these secondary movements taking place. Thecapsular rent, which may be longitudinal or transverse,
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FRACTURES OF THE LOWER EXTREMITY. 251 sometimes lias to be enlarged by appropriate movements.In some cases it forms a true obstacle to reduction, thatcannot be removed without operative intervention. Ihave repeatedly reduced a dislocation of several weeksstanding in this way and obtained perfect mobility. Invery old cases all hope of obtaining a movable joint mustbe abandoned and a resection or a subtrochanteric osteot-omy performed to correct the position of the limb. (B) Forward Dislocation (Luxatio antica sive prae-cotyloidea). (Plates 51 and 52.) The forward dislocation is rarer than the backwardvariety. After the detailed description which has beengiven of posterior dislocations, but little space need bedevoted to it. An anterior dislocation may be produced artificially byoutward rotation and abduction of the thigh. The capsulegives way in its anterior portion, somewhat above themiddle, and if the thigh is at the same time overextended,a suprapubic dislocation results. If the tea

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