16. Extension so important in the reduction of other luxations, renders
scarcely any service in this: impulsion alone answers the purpose. If
the displacement be forward, it is reduced in the following manner: The
patient sits or stands indifferently; the latter position, however, has
sometimes this advantage over the former, that by placing the part to
be operated on more on a level with the hands of the surgeon, it gives
him both more readiness and more force in his motions: one assistant
supporting the elbow, separates the arm a little from the body; while
another taking hold of the hand and fingers, gives them also an equable
support.
17. The surgeon grasps the extremity of the fore-arm, with both hands,
one placed on its internal, and the other on its external side, so
that his two thumbs may meet before, between the ulna and the radius,
and the fingers behind. He then exerts himself to separate the two
bones from each other, by pushing the radius backward and outward,
and retaining the ulna in its place; in the mean time the assistant
who supports the hand, endeavours to move it in the direction of
supination, and consequently to draw the radius, with which it is
connected, into the same state. Being thus pushed in a direction
opposite to that of its displacement, by two forces, the one exerted
directly on it, and the other acting indirectly, the radius is forced
outwards, and the ulna, returning through the opening in the capsule,
is replaced in the sigmoid cavity.
18. Should a luxation of the radius backwards ever occur, the same
process executed in an inverse direction, would serve the purposes
of reduction. The surgeon with his fingers would have to press the
extremity of the radius forward and inward, while a forcible pronatory
movement impressed by the assistant on the hand intrusted to him, would
favour the effort and finish the reduction.
19. The disappearance of the signs (12 ... 14) of the luxation bespeak
its reduction. In general the pain is entirely removed; sometimes a
perceptible sound, or report, caused by the passage of the bone through
the opening in the capsule, announces the replacement.
20. When the luxation is of long standing, it is always attended with
more or less difficulty, occasioned by the adhesions of the surrounding
soft parts to the articulating surfaces, by the thickening of the
capsule, which diminishes the size of its opening, by the rigidity
contracted by the whole part, &c. It is, in such cases, useful to
employ emollient applications for some time previously to attempting
the reduction, in order to produce such a relaxation, and diminution of
the congestion, as may favour the efforts of the surgeon.
21. The first patient whom Desault visited at the Hotel-Dieu in quality
of surgeon in chief, had a luxation forward, of more than two months
standing, in which the use of these means facilitated the reduction:
but they are sometimes insufficient, and then the radius remains
immoveable, and the forearm performs its motions but partially.
22. It would seem as if nature, always industrious to provide, amid
the disorders of our organs, some resources for the exercise of their
functions, has been desirous of preventing here, the inconvenience
attendant on a failure of reduction, by rendering luxations backward
much more difficult than those forward. Indeed if the fore-arm be kept
constantly in a state of supination, it will be much less useful, than
if it were always in a state of pronation, the situation in which most
of the motions necessary to our existence are performed.
§ VI.