A system of surgery . Fig. 388.—Method of Kocher. Advancement of the elbow forwards, upwards, and inwards,-still maintaining external rotation. continuous sweep, and not with jerky intervals (Figs. 387, 388,389). Explanation of Kochers method.—When the fore-arm and armare rotated outwards, the upper part of the capsule and the coraco-humeral ligament are also twisted outwards, and the posterior anduntorn part of the capsule is removed from the glenoid fossa, whilethe gap inferiorly gapes wider and wider as the external rotation isproceeded with. When the arm is raised and carried towards the 9
A system of surgery . Fig. 388.—Method of Kocher. Advancement of the elbow forwards, upwards, and inwards,-still maintaining external rotation. continuous sweep, and not with jerky intervals (Figs. 387, 388,389). Explanation of Kochers method.—When the fore-arm and armare rotated outwards, the upper part of the capsule and the coraco-humeral ligament are also twisted outwards, and the posterior anduntorn part of the capsule is removed from the glenoid fossa, whilethe gap inferiorly gapes wider and wider as the external rotation isproceeded with. When the arm is raised and carried towards the 976 DISLOCATIONS. median line, the head of the bone passes from the edge of the glenoidfossa through the gap. For this latter manipulation relaxes the upperpart of the capsule, but renders tense the untorn fibres of the lowerpart, so that the head of the bone cannot move forwards. Rotationinwards completes the position of the head of the Fig. 389. -Method of Kocher. Eotation inwards, the hand being carried towards the oppositeshoulder. 2. Traction with the knee in the axilla,—This is a power-ful and efficacious method. The patient being secured by broad ban-dages in the sitting or reclining position, the surgeon brings hisknee well into the axilla against the head of the bone. Assistantsnow make extension outwards from the fore-arm or arm with orwithout the aid of a strong towel. At a signal from the surgeonthe direction of the force is lowered, he, at the same time, bendingdown the humerus over his knee (Fig. 390). DISLOCATIONS OF TEE SEOULDEB. 977 3. Extension with the heel in the axilla.—This simpleand valuable method is often bungled in practice; but if properlycarried out, I would venture to look upon it as the simplest andmost reliable method of reducing dislocations of the humerus. Theanaesthetised patient must lie perfectly flat on a mattress, on the floor,and the surgeon, seated by his side, presses his u
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