The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XLIII. Of the thigh-bone dislocated backwards.

SEldome also is the thigh-bone dislocated backwards, because the hind part of the cavity of the huckle-bone is deeper and more depressed than * 1.1 the fore; whence it is that the dislocation of the thigh to the inner part is more frequent than the rest. The patient can neither extend nor bend his legge by reason of the much compression and tension of the muscles which encompasse the head of the thigh by this kind of luxation. But the pain is en∣creased when he would bend his ham, for that then the muscles are the more strongly extended. The lame leg is shorter than the sound: when the Buttocks are pressed, the head of the thigh is perceiued hid amongst the muscles of that part; but the opposite groine is laxe, soft, and deprest with a manifest cavity. The heele touches not the ground, for that the head of the thigh is plucked backe againe by the muscles of the buttocks amongst which it lyeth hid, but principally by that which is the larger, and which is said to make as it were the pillow or cushion of the buttocks; for this is much more pressed in this kinde of dislocation than the rest: whence it is, that the patient cannot bend his knee, because the extension of the nervous production or large tendon which covers the knee is so great. But if the patient will stand upon the foot of his luxated legge without a staffe, he shall fall down backwards, for that the body is inclined to that part, the head of the thigh being not directly underneath for the propping or bearing up of the body; wherefore he is forced to sustaine him∣selfe upon a crutch on his same side. Having premised these things of the differen∣ces, signes, symptomes and prognosticks, it now remaineth, that we briefly describe

the different wayes of restoring them, according to the difference of the parts whi∣ther it is fallen. First, you must place the patient upon a bench or table, groveling, * 1.2 or with his face upwards, or upon one side, laying some soft quilt or coverlid under him, that he may lye the easier. Now you must place him so, that the part unto which the bone is flown, may be the higher, but from whence it is fled, the lower. For if the thigh-bone bee dislocated outwards or backwards, then must the patient bee laid groveling; if inwardly, upon his backe; if forwards, then upon his side. Then must extension and impulsion be made towards the cavity, that so it may bee forced thereinto: but if the dislocation be fresh, & in a soft body, as a woman, childe, and such like, whose joynts are more laxe, it shall not bee any waies needefull to make great extension with strong ligatures for the restoring it; the Surgeons hand shall suffice, or a List or towell cast about it. In the interim the bone shall bee kept fast with compresses applyed about the joynt: then the Surgeon shall extend the thigh, taking hold thereof above the knee, in a straight line, and so set it directly against the cavity, and then presently thrust it thereinto. For thus shall he restore it, if so bee that in thrusting it, hee lift up the head thereof somewhat higher, lest the lips of the cavity force it backe, and hinder it from entring. Now because unlesse there bee just extension, there can be no restitution hoped for, it is farre better in that part, that is, to extend it somewhat more than is necessary, yet so, that you doe not endanger the breaking of any muscles, tendon or other nervous body. For, as Hippocrates * 1.3 writes, when as the muscles are strong and large, you may safely extend them, if so be that you displace nothing by the force of the extension. If your hand will not suffice to make just extension, you must use the helpe of an Engine, such as is our Pul∣ley, fastened to two postes, so much of the rope being let forth, and drawn up again, as shall suffice for the businesse in hand; in the performance whereof, it is fit that the patients friends absent themselves from this sad spectacle, and that the Surgeon bee resolute, and not deterred from his businesse by no lamentation, neither of the pati∣ent nor his friends. But for that we write these things chiefely for the benefit of young practicioners, it seemeth meet, that having delivered these things in general, of restoring the thigh-bone, that we run over these generalities in each particular, beginning with that dislocation which is made inwardly.

Notes

• * 1.1

  Signes.
• * 1.2

  The generall cure.
• * 1.3

  Sect. 2. lib. de fract.