Compleat Surgeon/Luxations
A TREATISE OF THE OPERATIONS Which are perform'd in LUXATIONS.
CHAP. I.[edit]
Of the Luxation of the Nose.[edit]
The Bones of the Nose may be separated from that of the Fore-head by a Fall, or some violent Blow; and the Surgeon in order to set 'em, at first lays his Thumb upon the Root of the Nose, and then he introduceth a little Stick trimm'd with Cotton, into the Nostrils, and by the means thereof thrusts back the Bones into their place.
The Dressing and Bandage[edit]
Are the same with those that have been already describ'd in the Fracture of the Bones of the Nose.
CHAP. II.[edit]
Of the Luxation of the lower-Jaw.[edit]
The Jaw may be luxated either on both sides, or only on one. When the Dislocation happens on both sides, it hangs over the Sternum or Breast-Bone, and the Spittle runs abundantly out of the Mouth: To reduce it, the Patient must sit down, and his Head is to be supported by a Servant; then the Operator or Surgeon having wrapt up his two Thumbs, puts 'em into the Mouth upon the Molar Teeth, his other Fingers lying under the Jaw, which is to be drawn down by raising it up, having before set two small Wooden Wedges upon the two Molar Teeth on both sides of the Jaw, lest the Surgeon's Fingers shou'd be hurt, as the Bone is returning to its place.
If the Luxation be forward, a Band or Strap is to be put under the Chin, an Assistant having his Knees upon the Patient's Shoulders, where he is to draw the Strap upward, to facilitate the Extension; which the Surgeon makes with his Hands, at the same time thrusting the Bone back again into its place.
When the Jaw is luxated only on one side, the Chin stands a-cross, and the dislocated side is squash'd down, a small Cavity being perceiv'd in it, and a Rising on the other side; so that the Mouth cannot be shut close, but remains somewhat open, the lower Teeth appear farther out than the upper; and the Canine or Dog-Teeth lie under the Incisive. This Luxation is reduc'd by giving a blow with the Hand upon the luxated Bone, which is sufficient to cause it to re-enter its Natural Place.
The Dressing and Bandage[edit]
Are altogether the same with those us'd in the Fracture of the Bones of the lower Jaw.
CHAP. III.[edit]
Of the Luxation of the Clavicle.[edit]
The Clavicle is oftner loosen'd from the Acromion than from the Sternum; when it hath left the former the Arm cannot be lifted up; the Acromion makes a Prominence, and the Clavicle descends downward, a Cavity appearing in its place. To reduce this Luxation, the Patient is to be laid upon some Convex Body put between his Shoulders; both which are to be press'd backward, to raise up the Clavicle: Afterward he is to be set in a Chair, that his Arm may be drawn backward, whilst the Surgeon is employ'd in pressing the Clavicle and Acromion, to join 'em together.
The Dressing and Bandage[edit]
Are the same with those that we have already shewn, in treating of the Fracture of the Clavicle.
CHAP. IV.[edit]
Of the Luxation of the Vertebra's.[edit]
In the Luxation of the Vertebra's of the Neck, the Head stands to one side, and the Face is swell'd and livid, with a difficulty of Respiration.
To reduce this Dislocation, the Patient is to be set upon a low Seat, an Assistant leaning on his Shoulders, to keep his Body steady, whilst the Surgeon or Operator draws his Head upward, and turns it from one side to another: Then if the Accidents or Symptoms cease, the Cure is perform'd; so that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, must take care to avoid moving his Head.
When the Vertebra's of the Back or Loins are luxated on the inside, a sinking of the Bone is soon perceiv'd; whereupon the Patient being laid on his Belly, the Extension is to be made with Napkins pass'd under the Arm-Pits, and upon the Os Ileum, whilst the Surgeon with a strong Extension makes some Efforts on the Spine, endeavouring to draw back the Vertebra. If that be not sufficient, an Incision is to be made upon the Apophysis Spinosa of the Vertebra; so that after having laid open this Process of the Bone, it may be taken out with a Pair of Forceps. Then the Wound is to be dress'd with Pledgets, a Plaister, and a Napkin, which must not be bound too close, for fear of pushing back the Spine.
When the Vertebra is luxated on the outside, a Prominence appears; so that to reduce this Dislocation, the Extension is to be made as before, the Patient lying in like manner upon his Belly; but in order to push back the Vertebra, two little Sticks trimm'd with Linnen-Cloth are to be prepar'd, and laid along the two sides of the Spine of the Vertebra; yet these Sticks ought to be thick enough to remain more elevated than the Apophysis Spinosa; and a large wooden Roller is to be often roll'd upon 'em, which by its turning backward and forward, may thrust the Vertebra's inward; so that when all the Vertebra's are of an equal height, the Reduction is finish'd. If the Vertebra's are luxated on the side, the same Extensions are to be made, and the Prominence is to be push'd, to re-establish the Vertebra in its place.
The Dressing and Bandage.[edit]
The Dressing is prepar'd by laying two thin Plates of Lead on each side of the Spinous Process of the Vertebra, to maintain it in its Place, and a long Bolster over 'em. The proper Bandage is the Quadriga, which hath been before describ'd, in treating of the Fractures of the Breast-Bone.
CHAP. V.[edit]
Of the Luxation of the Coccyx or Rump-Bone.[edit]
If the Coccyx be sunk on the inside, it is to be rais'd with the Fore-finger of the Right-hand put into the Anus; and if the Luxation be on the outside, it may be gently thrust back again. An Account of its proper Dressing and Bandage hath been already given in the Fracture of the Coccyx.
CHAP. VI.[edit]
Of the Bunch.[edit]
The Bunch is nothing else but an exterior Luxation of the Vertebra's, and for the Cure thereof, it wou'd be requisite to keep Emollients for a long time upon the Vertebra's, to loosen the Ligaments, and to wear Iron-Bodice; which in compressing the Vertebra's by little and little, might perhaps drive 'em back into their Natural Place.
CHAP. VII.[edit]
Of the Luxation of the Ribs.[edit]
The Ribs are luxated either on the outside, or on the inside: If they be dislocated on the inside, a Cavity is perceiv'd near the Vertebra's, the Patient drawing his Breath with Pain, and not being able to bend his Body.
When the Luxation is on the outside, and happens in the upper Ribs, the Patient's Hands are to be hoisted upon the top of a Door, to raise up the Ribs, whilst the Surgeon presseth the Prominence of the Rib to restore it to its place.
When the lower Ribs are luxated, the Patient must be oblig'd to stoop, laying his Hands upon his Knees, and the Prominence of the Bone is to be thrust back.
If a Rib be luxated on the inside, an Incision is to be made to draw it out with the Fingers.
The Dressing and Bandage[edit]
Are the same with those that are us'd in the Fracture of the Ribs.
CHAP. VIII.[edit]
Of the Sinking of the Xiphoides, or Sword-like Cartilage.[edit]
To raise up the Xiphoid Cartilage, it must be fomented before for some time with Oil of Turpentine, or other Fomentations, made with Aromaticks; then the Patient is to be laid upon his Back, with a Convex Body underneath, and the Shoulders, and Sides of the Breast are to be press'd, to lift up the Cartilage. When this Operation is not sufficient, dry Cupping-Glasses are usually apply'd, till the Part be elevated, and a strengthening Plaister is afterward laid upon it.
CHAP. IX.[edit]
Of the Luxation of the Humerus, or Arm-Bone.[edit]
The Head of the Humerus generally falls under the Arm-Pit, so that the luxated Arm becomes longer than the other, the Acromion appears pointed on the outside; the Elbow starts from the Ribs, and cannot be mov'd without great Pain. To reduce this Bone, the Patient is to be set upon a low Seat, or else on the Ground, whilst some Person supports his Body with a Napkin: In the mean time the Surgeon is to lay hold on the upper-part of the Humerus, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to pass between the Surgeon's Legs, and is to be drawn down by the Assistant as much as is possible, whilst the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was stopt; insomuch that the Bone sometimes makes a Noise in re-entring its Cavity.
Or else the Patient's Arm may be laid upon the Shoulder of a taller Man than himself, who is strongly to draw the luxated Arm upon the Fore-part of his Breast; during which time, the Operator is to push the Head of the Humerus, to cause it to re-enter its Cavity.
Otherwise the Patient may lie on the Ground, a Tennis-Ball being put under his Arm-Pit, which a Servant is to draw strongly with a Handkerchief pass'd under the Shoulder, whilst another Assistant stands behind the Patient, to thrust down the Shoulder with his Foot; at the same time the Surgeon sitting between the Patient's Legs, is to push strongly with his Heel the Ball that lies under the Arm-hole.
Or else, a thick Battoon or Leaver may be laid on the Shoulders of two Men, after a Tennis-Ball hath been nail'd on the middle of it; otherwise a Bunch may be made therein, and cover'd with Linnen-Cloth; two Wooden Pins being also fixt on each side of the Ball: Then the Patient's Arm-Pit is to be set between those two Pins, and upon the Ball, where he is to remain hanging, whilst his Arm is pull'd down by main force. The same thing may be done by laying the Patient's Arm-Pit upon a Door, or else upon the Round of a Ladder.
The Dressing and Bandage[edit]
A little Ball of Linnen is to be laid under the Arm-Pit, and underneath a Bolster with four Heads, which are cross'd upon the Shoulder; as also a Bolster under the sound Arm-Hole, that it may not be gall'd by the Bandage Spica, the Nature of which we have shewn in treating of the Fracture of the Clavicle.
CHAP. X.[edit]
Of the Luxation of the Elbow.[edit]
When the Elbow is luxated on the inside, the Arm flies out, and the Hand is turn'd outward; but in the Luxation on the outside, the Arm is shortned: If the Luxation be Lateral, a Prominence appears in the Dislocated, and a Cavity in the opposite Part.
To reduce the Internal Luxation, the Humerus and Cubitus are drawn, and at the same time the Surgeon bends the Elbow, by carrying the Hand toward the Shoulder; or else a Tennis-Ball may be laid in the Fold of the Elbow, and the Arm drawn toward the Shoulder.
For the External Luxation, the Extension is to be made, whilst the Surgeon thrusts back the Elbow into its place: Or else a round Stick may be taken, and trimm'd with Linnen-Cloth, with which the Bone is to be push'd back into its place during the Extension. This Stick may be also us'd in the reducing of the Internal Luxation.
For the Lateral Luxations, the Extension may be made in like manner; the Surgeon at the same time thrusting back the Bone into its Natural Situation.
The Bandage[edit]
Is made with a Band five Ells long, and two Fingers broad, roll'd with one Ball: The Application of it is begun with a Circumvolution at the lower part of the Humerus, it is pass'd over the Fold of the Arm; a Circumvolution is also form'd in the upper-part of the Elbow, and the Figure of KY in its Fold. Afterward the Rollers are continu'd upon the Elbow, and the KY's in the inside of the Arm, till the Elbow be entirely cover'd: The Band is likewise carry'd up to the top of the Arm with Rollers, and stay'd round about the Body. The Patient must be oblig'd to keep his Bed, or else his Arm may be put in a Scarf, after the same manner as in the Fracture of the Arm.
CHAP. XI.[edit]
Of the Luxation of the Wrist.[edit]
If the Luxation be Internal, the Hand is turn'd back to the outside, so that for the Reduction thereof, it wou'd be requisite to cause the back of the Hand to be laid upon a Table, and the Extension to be made by drawing the Elbow and Hand, whilst the Surgeon takes care to press the Prominence.
If the Luxation be External, the Hand is bended on the inside; so that to reduce it, the inside of the Hand is to be laid upon a Table, and the Surgeon is to press it after the Extension.
If the Luxation be on the sides, the Hand is turn'd to one side; so that the Extension must be made, and the Hand turn'd on the side opposite to the Luxation. But the Fingers are usually drawn one after another, to the end that the Tendons may be set again in their Place.
The eight Bones of the Carpus may be in like manner dislocated both on the inside and without; and to set 'em right, the Hand is to be laid upon a Table, and the Extension to be made, so as to press the Protuberances on the inside, if the Luxation be internal, and on the outside if it be external.
The Bandage[edit]
Is prepar'd with a Band six Ells long, and two Fingers broad; so that three Circumvolutions may be made upon the Luxation; as also divers Rollers in passing thro' the inside of the Hand between the Thumb and the Forefinger, and in forming the Figure of KY upon the Thumb, after having made many Rollers upon the Wrist. Two Pieces of Paste-board are also to be laid on the sides of the Wrist, which are bound with the same Band in making Rollers; and the Hand is to be trimm'd with a Linnen-Ball, to keep the Fingers in their mean Situation. Then the Band is to be pass'd above, to strengthen it, and carry'd up with Rollers along the whole length of the Elbow, to be stay'd below the same Elbow.
CHAP. XII.[edit]
Of the Luxation of the Fingers.[edit]
If the Fingers be luxated, it is necessary to make an Extension to reduce 'em, and afterward to use the following
Bandage.[edit]
If the Luxation be in the first Articulation or Joint, the Bandage Spica is to be apply'd, being made of a Band roll'd with one Head, an Ell long, and an Inch broad: It is begun with Circumvolutions round about the Wrist, and brought over the Luxation in passing between the Fingers. These Circumvolutions are also continu'd to form a Spica upon the Luxation; and the Band is stay'd at the Wrist.
If all the first Phalanges were dislocated, it wou'd be requisite to make as many upon every Phalanx, and with the same Band: This sort of Bandage is call'd the Demi-Gantlet.
CHAP. XIII.[edit]
Of the Luxation of the Thigh.[edit]
The Luxation which most commonly happens in this Part, is the Internal; so that a Protuberance appears on the Hole of the Os Pubis; the indispos'd Leg is longer than the other, and the Knee and Foot turn outward; neither can the Thigh be any longer bended, nor drawn near the other.
If the Luxation be External, the Leg becomes shorter than the other, the Knee and Foot turning inward, and the Heel to the outside.
When the Luxation is on the fore-part, a Tumour ariseth in the Groin, so that the Patient cannot draw this Thigh toward the other, nor bend the Leg; his Body resting only upon the Heel.
If the Luxation be Posterior, a Tumour is felt in the Buttocks with great Pain, and the Legg is shorter than it ought to be: There also appears a sinking in the Groin, the Leg is lifted off from the Ground, and the hurt Person is apt to fall backward.
To reduce the Internal Luxation, the Patient is to be laid with his Back upon a Table, to which is fixt a thick Wooden Pin, about a Foot long, which is to be set between his Thighs, to detain his Body when his Legs are drawn down; then a Strap is to be pass'd above the joynt of the Thigh, to draw the Ischion upward; and the Thigh is to be drawn down with another Strap fasten'd above the Knee: In the mean while the Surgeon thrusts the Thigh upward, to cause it to re-enter its Cavity, the Straps being somewhat loosen'd in the time of the Reduction to facilitate the Operation.
To reduce the External Luxation, the Patient is to be laid upon his Belly; and the drawing to be perform'd after the same manner as we have even now shewn, whilst the Thigh is thrust from the outside inward, to cause the bone to re-enter its Cavity.
In reducing the Anterior Luxation, the hurt Person is to be laid upon the side opposite to the Luxation, and Extensions are to be made, by drawing both upward and down-ward, as before: Then the Head of the Bone is to be forc'd, by the means of a Ball thrust strongly with the Knee, in drawing the luxated leg toward the other.
The Posterior Luxation is thus reduc'd; The Patient being laid upon his Belly, the double Extension is to be made, and his Knee drawn outward, to set the Bone in its place. After the Operation hath been perform'd, a Bolster is to be apply'd, steept in Spirituous Medicaments; and the Bandage call'd Spica, of which we have given an Account in treating of the Luxation of the Shoulder.
CHAP. XIV.[edit]
Of the Luxation of the Knee.[edit]
When the Tibia is luxated behind, its Prominences are in the Cavity of the Ham, and the Leg flies off, or is bended. If the same Tibia be dislocated on the side, a kind of Tumour appears in the luxated side, and a Sinking in the opposite. But if the Condylus of the Tibia remains in the inside, the Leg turns outward; and if it be in the outside, it turns inward.
The Posterior Luxation is reduc'd by obliging the Patient to lie upon his Belly, whilst the Surgeon during the Extensions bends the Leg, in drawing the Heel toward the top of the Thigh.
If the Tibia be luxated on the side, the usual Extensions are to be made, and the Bone is to be push'd with the Knee.
If the Luxation were in the fore-part, it wou'd be requisite to lay the Patient upon his Back, to make the Extensions, by drawing the Thigh and Leg; and to press the protuberant Parts.
The Bandage[edit]
Is prepar'd with a Band three Ells long, and two Fingers broad, roll'd with two Balls: A Circumvolution being at first made above the Knee, the Figure KY is form'd underneath, and a Circumvolution above it; then the Band is carry'd up again over the Knee, in making Rollers and KY's underneath, till the Knee be entirely cover'd.
CHAP. XV.[edit]
Of the Luxation of the Patella or Knee-Pan.[edit]
The Knee-Pan is luxated by starting upward; and to reduce it, the Patient's Leg is to be held streight, whilst it is thrust back into its place with the Hands. Then he must be oblig'd to keep his Bed; and the same Bandage is to be apply'd with that which hath been describ'd for the Luxation of the Knee.
If the Perone or Fibula be remov'd from the Tibia, the sides of the Foot are to be press'd, to draw it back again; and it may be kept close with the Bandage which is appropriated to the Fractures of the Tarsus.
The Astragalus may be also luxated in the fore-part; so that the Operator ought to thrust it back into its place, and to make use of the Bandage which we have prepar'd for the Fracture of the Foot.
The Calcaneum sometimes flies off from the Astragalus both in the inside and without; and the Bones of the Tarsus, Metatarsus, and Toes are likewise apt to be luxated. But a little Circumspection is only requisite to reduce all these Dislocations.