MR. ABERNETHY'S

1826 The Lancet  
Accidents occurring about the Hip Joint. You know the numerous,obstacles that oppose a dislocation upward and backward ; but, notwithstanding those obstacles, forces are so continually occurring to dislodge the thigh bone in that direction, that really the dislocation often happens ; the bone is thrown out of the socket through the thick part of the at'ttCM/a)' ligament, and it slips over upon the dorsum of the ilium, generally with the head turned backwards. Now whether it lies on the dorsum
more » ... ies on the dorsum of the ilium, or slips down into the sacaal notch; does not appear to me to be a point of importance ; therefore I make no distinction between those two cases. Then here is a dislocation characterisedby thefollowingcircumstances: the limb is shorter than the other, and inverted ; it is beyond the limits of the acetabulum, which shortens the length of it, and it is inverted. You cannot turn it out; the head strikes against the bone ; then, I say, it is clearly indicated by those circumstances, and there is no difficulty in the method of using force to a dislocation so simple. You have nothing to do but to pull the knee with the thigh bent at a half right angle upon the pelvis, then the head of the bone will come down below the acetabulum, and having got it there, it generally slips into the socket. You cannot pull it over the acetabulum ; you cannot pull it over the great ridge that is there, but you bring it down where the bone has no great rise in it, for there is below the acetabulum a groove, between the acetabulum and the tuberosity of the ischium, in which the obturator moves, and it is along this groove, provided you pull at the angle specified, the bone will come : and when it gets below the brim of the acetabulum, it slips in. I say, I cannot make a distinction in those two cases ; there are some, however, who say, you must lift the head of the bone over the socket, but I know nothing about that, nor have I ever found any necessity for it. All I have seen of such cases have been easily reduced, and I can say this, that I have reduced the dislocated thighs of very strong and muscular men, in inns, and at such places, where they have been brought after having been pitched off coaches, with no other assistance than that of a waiter or two, and a four-post bedstead. Now the first thing is, to steady the pelvis of the subject; and this is done by putting a sheet round the thigh, crossing it round the groin, putting it over the pelvis, twisting it hard and tight, and then securing it to the bed-post. Mr. Hey, of Leeds, has told a good thing with respect to how you are to make soft cords for pulling dislocations : get any number of yards of calico you please, roll them up into a rope, and it is a cylinder of calico, soft and pliant, and, egad, of enormous strength ; clap it round, as I have described, twist it harder and harder ; then, when it is of the length you wish it, you can put one hand between the ticking of the bed and the posts of the bed, bringing it round one of the bed posts, and tying some hard knot-a bowling knot, or something of that kind. And you must learn to make these knots, for, egad, any thing giving way when you are pulling, is the most vexatious thing that could possibly be. Well, I fix my patient, and let one bedpost be diagonally opposite to the knee ; then I put the rope round the knee, and then I put it round the bed-post ; then I say, Come and lean upon this. Now this is unremitting pulling. I see his muscles giving way ; then I say, Come, let us only have another hitch or two ; then you twist it round the bed-post again; and then, by going on perseveringly, wearying the man, it has "come in, in six or seven, or eight minutes. But if there is a case of difficulty,
doi:10.1016/s0140-6736(02)92215-4 fatcat:bygjesfo2vfwtpqclqhlh2l4vm