Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. VIII.

Of the Luxation of the Thigh.

THe Thigh has a round Head, growing in a long Neck, which is inserted into a very deep Sinus. The Thigh is bound to the Os Coxendicis by two Liga∣ments, the one orbicular, and the other round. Hence it is apparent that only a perfect Luxation can happen in the Thigh, and not an imperfect one, as we said before of the Shoulder. The Thigh slips forward, backward, outward or in∣ward. But it is done with great difficulty. First, because of the very strong Muscles, and abundance of Flesh upon those Muscles, which keep the Thigh in its proper Si∣nus. Secondly, because of the depth of the Acetebulum. Thirdly, because of two tight and short Ligaments. The Thigh is seldom luxated for∣ward or backward, because in these sides the edges of the Aceta∣bulum are highest; sometimes out∣ward, because there they are not so high; oftnest inward, because there the edge is lowest. And be∣sides the lowness of the edge I may add the round Ligament, which is inserted next the inside, and there∣fore will more easily give way to Luxation of the Thigh inward.

If the Thigh be luxated inward; it appears longer than the other, because the Thigh desconds. Also the Knee, Leg and Foot stand out∣ward; For if one end of a thing encline one way, the other end will encline the contrary: where∣fore if the Head of the Thigh be displaced inward, the Knee, Leg and Foot encline outward. Be∣sides, the Thigh cannot be brought toward the Groin; because the inflexor Muscles are straitned and hindred, that they can neither lift nor bend the Thigh. Another sign is, that on the Region be∣tween the Anus and the Testicles, a manifest Tumor appears in the outer side of the Sinus. If the Thigh slip outwards, the signs are contrary: for that Leg is shorter than the other, because the Head is more elate than its Sinus. Be∣tween the Scretum and the Anus there is a hollowness; and towards the Buttocks there is a swelling. The Knee, Leg and Foot stand in∣ward. The Heel cannot touch the ground, because the Leg is short∣ned: but the Patient can draw his Thigh upward, because the in∣flexor Muscles are not hindred. If the Knee slip forward, the extended Thigh cannot be bent, because the inflexor Muscles are hindred and pressed by the head of the Thigh.

Urine is stopt in such Persons, because the head of the Thigh presses upon the Bladder. The Groins swell, be cause the head of the Thigh is slipt into these parts. The Buttocks appear wrinkled and without Flesh; because the whole Thigh, toge∣ther with the Processes, is slipt for∣ward. If the Thigh be slipt back∣ward, there are the contrary signs. The Leg cannot be extended, be∣cause the extending Muscles, which are behind, are prest; wherefore they cannot be drawn toward their proper Principles; the Thigh af∣fected is shorter than the other, because the Head is got above the Sinus; the Heel cannot touch the ground. The Groin appears lax, and the head of the Thigh sticks out at the Buttocks.

It is very difficult to replace a dislocated Thigh; because, by reason of the very strong Muscles, extension cannot be made: and the difficulty is encreased, if the Luxation be not new, but callous by reason of Humors running to the Os Foemoris, and of the re∣pletion of the Sinus. The Thigh being replaced, it is apt to slip out again, because the Muscles are so weakned, that they are not able to keep the heavy Thigh in its Seat; and because the round Ligaments is either la••ated, or broken.

The Thigh may be replaced, either without or with extension. Without extension two ways, but never unless the Luxation be new, and moderate, i.e. standing but a little way from its Sinus, and in a Child's Body. The first way is, to turn round the head of the Thigh about the Hium (as we did when the Arm was out of Joynt) and not to separate it, if it get in∣to the Sinus. But this way is not safe, for fear lest the head of the Bone should rub against the edges of the Sinus, and so either bruise or break them. The other way is, to bend the Thigh suddenly: for so sometimes it is replaced accord∣ing to Paulus, c. 98. l. 6.

But the Thigh is best reduced with extension. If therefore the Thigh be slipt inward, thô there seems to be no need of extension, since the Leg is longer than it should be (not shorter, as in other Luxations, wherein the Muscles moving the head of the Bone, have their Original far above it, and so draw the head upwards) never∣theless a little extension must be made, as much as is sufficient to stir and extricate the fixt head. This may be done with the Hands, if the Luxation be new, moderate, and in a Child's Body. It must be performed in this manner; one Servant must hold the Patient's Body by the Armpits very fast; another must take hold of the Thigh with both his Hands above his Knee, and extend it. In the mean time, while extension is making, the Chirurgeon must with his Hands force the Thigh slipt inward, outward. When the Head is thus extricated by means of this impulsion, the Muscles that draw upwards, will easily put it into its place again; or, if the Muscles be weak, the Chirur∣geon may easily do it. If it be in a robust Body, we want stronger extension, which must be with Girts and Ropes. A Girt then

must be put on the space between the Genitals and the Anus; but so, as that it do not take hold of the head of the Bone. Then another Girt must be tied above the Knee, or another above the Ankle: and these Girts must be drawn by the two heads, either with the hands alone, or with a Ladder, to one of the staves whereof the up∣per Girt must be tied, and the Pa∣tient must be laid on the Ladder, and the other Girt must be drawn downward. You may also use the Scamnum Hippocratis. But these violent Extensions are most proper in other Luxations of the Thigh, when it is put outward, forward or backward: for when Extension is made, and the head is forced the contrary way, the Chirurgeon may easily reduce it. After reduction, Medicines must be applied, to pre∣vent Inflammation, asswage Pain, and to contract and strengthen the lax Ligaments.