. Modern surgery, general and operative. ing a depression below it, and the latter above it; the leg is semiflexed, butshortening is absent. Dislocation inward of the knee-joint is usually incomplete. The outertuberosity of the tibia in inward dislocation Hes upon the inner condyle of thefemur; the outer condyle of the femur forms an external prominence, and theinner tuberosity of the tibia forms an internal prominence. Pick cautions usnot to mistake a separation of the lower femoral epiphysis for lateral disloca-tion (the former is reduced easily, the deformity tends to recur, and there is so
. Modern surgery, general and operative. ing a depression below it, and the latter above it; the leg is semiflexed, butshortening is absent. Dislocation inward of the knee-joint is usually incomplete. The outertuberosity of the tibia in inward dislocation Hes upon the inner condyle of thefemur; the outer condyle of the femur forms an external prominence, and theinner tuberosity of the tibia forms an internal prominence. Pick cautions usnot to mistake a separation of the lower femoral epiphysis for lateral disloca-tion (the former is reduced easily, the deformity tends to recur, and there is softcrepitus). Treatment.—In treating lateral dislocation of the knee-joint, effect extensionand counterextension as in anteroposterior dislocations. The leg is movedfrom side to side and attempts are made at rotation. The after-treatmentis the same as that for anteroposterior luxations. Dislocation of the patella is seldom congenital. There are 35 congenitalcases on record (Bajardi). There are three forms of dislocation of the patella:. Fig. 478.—Old dislocation of the patella out-ward. Dislocation of the Semilunar Cartilages of the Knee-joint 773 outward, inward, and edgewise. The so-called dislocation upward is, in reality,rupture of the ligamentum patellas (see page 809). Dislocation of the patella outward (Fig. 478) may be due to muscularaction or to direct force, and occurs during extension of the leg. It occasionallyhappens on a person with knock-knee. If dislocation is complete the bonelies upon the external surface of the external condyle; if incomplete, the patellarests upon the anterior surface of the external condyle. The leg is extendedflexion is impossible, and attempts at flexion produce great agony. In thepatient shown in Fig. 478 flexion became possible in an unreduced dislocation,but not until months after the accident. The knee is wider than normal!There is a hollow in front of the joint. The bone is felt in its new position. Dislocation of the patellainwar
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