A system of surgery . rm outwards or inwards. This must be taken into account inestimating the vaunted infallibility of any one method. The chiefmodes of effecting reduction will now be described. 1. Method of Koeher.—This is of peculiar value, and iscommonly now adopted in the hospitals of England. It will beobserved that it combines external and internal rotation, which mani-pulations are especially valuable in the reduction of dislocations. Jnthe first part of this manipulation the fore-arm is bent, and the surgeon,grasping the wrist and elbow, abducts the limb and rotates it out-wards unti
A system of surgery . rm outwards or inwards. This must be taken into account inestimating the vaunted infallibility of any one method. The chiefmodes of effecting reduction will now be described. 1. Method of Koeher.—This is of peculiar value, and iscommonly now adopted in the hospitals of England. It will beobserved that it combines external and internal rotation, which mani-pulations are especially valuable in the reduction of dislocations. Jnthe first part of this manipulation the fore-arm is bent, and the surgeon,grasping the wrist and elbow, abducts the limb and rotates it out-wards until marked resistance is encountered and a distinct swellin?: DISLOCATIONS OF THE SHOULDER. 975 appears beneath the deltoid. Secondly, the elbow is brought for-wards, upwards, and inwards until it is opposite the median line, butstill maintaining external rotation and abduction of the , the arm is rotated inwards, the hand being carried towardsthe opposite shoulder. These movements should be executed in a. 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 bone.
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