Dislocation

“ When the dislocation is forwards, he directs us to make strong extension with the hands or with thongs, and then placing some round body upon the anterior part of the arm, to push the fore-arm over it suddenly to the shoulder. ”

“ Part LII When, then, a dislocation has not been reduced, but has been misunderstood or neglected, the leg, in walking, is rolled about as is the case with oxen, and the weight of the body is mostly supported on the sound leg, and the limb at the flank, and the joint where the dislocation has occurred is necessarily hollow and bent, while on the sound side the buttock is necessarily rounded. For if one should walk with the foot of the sound leg turned outward, the weight of the body would be thrown upon the injured limb, but the injured limb could not carry it, for how could it? ”

“ A dislocation is a displacement from each other of the articular ends of the bones which enter into the formation of a joint. A diagnosis can usually be made from certain objective and subjective symptoms, taken in conjunction with an accurate history of the manner in which the accident occurred. ”

“ What is to be done in a complicated Dislocation?
The Accidents must be first remov'd, and then the Bone may be set, which is impossible to be done otherwise; it being dangerous even to make an Attempt before, by reason of the too great Violence with which it is effected, and which would infallibly produce a Convulsion or a Gangrene.
If the Dislocation be accompany'd with a Wound, must the Wound be cur'd before any Endeavours are us'd to reduce it?
No, but the Symptoms of the Wound, which hinder the Operation, must be taken away, as the Swelling, Inflammation, and others of the like Nature ”

“ In some cases from a blow suspicions of dislocation are formed, although none has taken place, owing to the violent inflammation which supervenes. Wherefore, dislocation downwards may be thus ascertained. The affected shoulder, when compared with the sound one, appears very different, the upper part of the arm, whence the dislocation took place, seeming hollow; and (as mentioned with regard to the sub-luxation of the acromion,) the top of the shoulder appears sharper than natural; and the dislocated head of the arm is distinctly felt in the armpit. ”

“ The event of highest generalization or universality, in the form of those mineral veins, is fracture and dislocation. It is not, like that of the veins of strata, simple separation and measured contraction; it is violent fracture and unlimited dislocation. In the one case, the forming cause is in the body which is separated; for, after the body had been actuated by heat, it is by the reaction of the proper matter of the body, that the chasm which constitutes the vein is formed. ”

“ Celsus describes four different kinds of dislocation at the elbow, namely, forwards, backwards, and to either side. He also mentions that rare variety, in which there is a dislocation of the ulna, while the radius remains in its place. (See Sir Astley Cooper’s Lectures.) The other varieties are all well described, and suitable methods of treatment recommended. When there is a dislocation forwards the arm is extended, but cannot be bent; when backwards, on the contrary, it cannot be extended, and is shorter than natural. ”

“ In the case of a fault, for example, with a displacement of, say, one mile, where no indication of it is seen at the surface of the ground, we know that on one side of the fault a thickness of rock equal to one mile must have been denuded, but we do not know how much more than that may have been removed. For anything which we know to the contrary, hundreds of feet of rock may have been removed before the dislocation took place, and as many more hundreds after all indications of dislocation had been effaced at the surface. ”

“ Part LXXVI In dislocation forward, the same mode of extension should be made; but a person who has very strong hands, and is well trained, should place the palm of the one hand on the groin, and taking hold of this hand with the other, is at the same time to push the dislocated part downward, and at the same time to the fore part of the knee. ”

“ Dislocations—In a dislocation the head of a bone is pushed or pulled out of its socket. A person may be falling and in trying to save himself catch hold of something in such a way that he feels a sharp, sudden, severe pain, and may even feel the head of the bone slip out at the shoulder or elbow. ”

“ When the foot is dorsiflexed at the moment of injury the displacement is backward, but this is rare, as is also dislocation to one or other side, and dislocation by rotation, in which the talus is rotated in its socket. ”

“ The consequences of dislocation inward at the hip-joint are much greater than of dislocation outward at the hip-joint, but at the knee, although there be some difference, it is less; but the mode of either impediment is peculiar, their legs are more bandied when the dislocation is outward, but those who have dislocation inward stand erect on their feet with less freedom. ”

“ Because certain persons fancy that they have cured patients in whom the vertebra had undergone complete dislocation forward. Some, indeed, suppose that this is the easiest of all these dislocations to be recovered from, and that such cases do not stand in need of reduction, but get well spontaneously. Many are ignorant, and profit by their ignorance, for they obtain credit from those about them. ”

“ Every species of fracture, and every degree of dislocation and contortion, may be perceived in the form of mineral veins; and there is no other general principle to be observed in examining their form. ”

“ The well-established facts of the local parallelism of particular classes of mineral veins, already put in evidence in a preceding chapter, leave no doubt of the existence of some real symmetry of the systems of dislocation in every limited district. ”

“ Dislocations.—A dislocated joint is one that has been put out of place. It is best to allow a physician to treat a dislocation. Unskilled handling of a dislocated joint may not only increase the damage but it may permanently put the joint out of business. ”

“ Succussion on a ladder for dislocation of the spine. The patient is bound to the ladder by the lower part of the body, the upper hanging free. The ladder is raised by the pulleys and suddenly allowed to drop. ”

“ Hopkins has very correctly shown theoretically that the fissures produced by earthquakes are very instructive as regards the formation of veins and the phenomenon of dislocation, the more recent vein displacing the older formation. ”

“ Yet it [Pg 75] often happens that there is no irregularity at the surface to betray the existence of a dislocation. The ground may be flat as a bowling-green, and yet, owing to some great fault, the rocks underneath one end of the flat may be geologically many hundred feet, or even yards, higher or lower than the strata underneath the other end of the same level space. What has become of the missing strata? ”

“ These are the reasons why complete dislocation does not readily take place, and this is another reason, because there is seldom a necessity for swallowing so large pieces of food as would make a man gape more than he easily can, and dislocation could not take place in any other position than in great gaping, by which the jaw is displaced to either side. ”

“ He says that all varieties of dislocation could be reduced by it.
Hippocrates says that “the best thing for any physician who practices in a populous city is to have prepared a proper wooden machine with all the mechanical powers applicable in cases of fractures and dislocations, both for making extension and for levering. ”

“ Part X A dislocation may be recognized by the following symptoms:-Since the parts of a man's body are proportionate to one another, as the arms and the legs, the sound should always be compared with the unsound, and the unsound with the sound, not paying regard to the joints of other individuals (for one person's joints are more prominent than another's) , but looking to those of the patient, to ascertain whether the sound joint be unlike the unsound. ”

“ In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocations. Skill and address will often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual. ”

“ It is quite common to meet with faults where the strata on the one side have been depressed several hundreds—and in some cases thousands—of feet below those on the other; but we seldom find any indications of such on the surface, the inequalities on the surface having been all removed by denudation. Now, in order to effect this, a mass of rock must have been removed equal in thickness to the extent of the dislocation. ”

“ In a dislocation besides the ligaments being torn the bone is out of place at a joint causing the affected limb to be shorter or longer than its mate. Study how the bone slipped from its socket, for you must reverse the movements occurring at the time of accident in order to reduce the dislocation. ”

“ Faults are the most common of all the forms of disturbed stratification: but, except in particular cases, they are the least influential on the physical configuration of the country. All the rocks which are disturbed by any fault have experienced on one side the same movement, and to the same extent, excepting only those portions which have been subjected to violent pressure; and the bottom of the faults has never been reached, except when they terminate in another dislocation.
Relation of Faults, Mineral Veins, Dykes, &c., to the great Lines of disturbed Rocks. ”

“ At a very remote period of the past, the rocks comprising these various strata were subjected to some powerful natural force, which resulted in their fracture, dislocation, and the gradual upheaval of a large portion of them, producing at the point of disruption what is known to geologists as a fault. ”

“ All the principal circumstances which attend the dislocations of the strata along the planes of mineral veins, are equally witnessed in the cases of common rock dykes, and faults; the same general laws as to the relation of planes of strata and planes of dislocation apply, with similar exceptions; nor are there wanting in all these cases, proofs of the fact that some of the fissures have been subject to more than one movement. In mineral veins this is manifested by the striated surfaces of rock and veinstones ("slickenside") ”

“ And perhaps this is the most suitable mode of reduction in such a case of dislocation. The parts may be reduced by extension in a straight line, but less readily than thus.
42. If the arm be dislocated forward- this rarely happens, indeed, but what would a sudden shock not displace? for many other things are removed from their proper place, notwithstanding a great obstacle,- in such a violent displacement the part (olecranon?) which passes above the prominent part of the bones is large, and the stretching of the nerves (ligaments?) is intense ”

“ What are the means proper to be us'd in a simple Dislocation?
A speedy and simple reducing thereof, which is perform'd by stretching out the dislocated or luxated Member, and thrusting back the Head of the Bone into its natural place. Afterward the Joynt must be strengthen'd with a Fomentation made with Provence Roses, the Leaves of Wormwood, Rosemary, Camomile, St. John's-Wort, and Oak-Moss boil'd in the Lees of Wine and Forge-Water, keeping the Part well bound up, and sustain'd in a convenient situation. ”

“ The proximity of an easily fractured bone also contributes to prevent dislocation of certain joints—for example, fracture of the clavicle prevents an impinging force expending itself on the shoulder-joint; and the frequency of Colles' fracture of the radius, and of Pott's fracture of the fibula, doubtless accounts to some extent for the rarity of dislocation of the wrist and ankle-joints respectively. The immunity from dislocation which the joints of young subjects enjoy is partly due to the ease with which an adjacent epiphysis is separated. ”

“ When there is a small sub-luxation of many vertebræ together, the distortion occasions a circular flexure of the spine, and in this case some are apt to be deceived, and take it for a complete dislocation of one spine, whereas a complete dislocation of one spinal vertebra does not produce a circular but an angular flexure of the spine, which is attended with more danger. ”

“ He distinguishes dislocations into two classes; the first consisting of a separation of two bones naturally united, such as the scapula from the humerus, the radius from the ulna, the tibia from the fibula, the os calcis from the bones of the ankle, which last is of rare occurrence, and the second being a removal of the bone of a joint from its proper place. When a dislocation occurs, as he remarks, the finger discovers a cavity in the part, and inflammation and fever come on, followed sometimes by gangrene and convulsions. If not reduced, the limb wastes. ”

“ Dislocations call for a medico-legal investigation less often than fractures. They are less common in the old and where the bones are brittle, when fracture occurs more readily. They are seldom fatal per se, unless between the vertebræ or when compound. They may occur from disease in the affected joint or even spontaneously. The diagnosis of a dislocation is easy until it has been reduced, and then it may leave no trace except pain in and limitation of the motion of a joint besides swelling and ecchymosis. ”

“ Earthquakes are now looked upon generally as signs of abrupt yielding to intense pressure. Sometimes they indicate that a huge weight of material deep down has slid to a lower level, packing more closely or pushing aside other masses, and causing what miners call “a fault”—that is a break or dislocation in the regular lines of the stratified rocks. ”