. A practical treatise on fractures and dislocations. matismcannot be positively made. Un-der such circumstances the manip-ulations that would reduce a dis-location if it were present shouldbe carefully made. If they re-duce the deformity and relievethe symptoms they both establishthe diagnosis and cure the bilateral dislocation forwardthe symptoms vary greatly. Thehead may be bent far forwardtoward the chest with markedprominence in the nape of theneck of the spinous process ofthe vertebra next below the dis-located one, or it may be bentbackward or backward and to oneside, with ma
. A practical treatise on fractures and dislocations. matismcannot be positively made. Un-der such circumstances the manip-ulations that would reduce a dis-location if it were present shouldbe carefully made. If they re-duce the deformity and relievethe symptoms they both establishthe diagnosis and cure the bilateral dislocation forwardthe symptoms vary greatly. Thehead may be bent far forwardtoward the chest with markedprominence in the nape of theneck of the spinous process ofthe vertebra next below the dis-located one, or it may be bentbackward or backward and to oneside, with marked projection ofthe trachea and perhaps larynx,and irregularity in the outline ofthe front of the column recogniz-able by palpation through the softparts. The head may be rigidlyfixed, or, more rarely, freely mov-able. These differences dependpartly on the position of the dis-located bone, the presence orabsence of associated fracture, and the extent of the injury to the con-necting ligaments, partly on the direction and character of the dislocat-. Bilateral dislocation forward of the fifth cer-vical vertebra. (From a photograph.) DISLOCATIONS OF Tlll<: CERVICAL VERTEBRM 513 ing force, and partly On the contraction or relaxation of the muscleswhich control the position taken by the unaffected joints above fix sealof injury. In the majority of cases the head is bent forward, and anangle with its apex directed backward is formed by the two segmentsabove and below the dislocation. Attempts to move the head andpressure at the seat of injury are very painful. In these patients theirregularity in the line of the transverse; processes may sometimes berecognized by the touch ; and if the dislocation is not too low the pro-jection of the body of the vertebra may be felt in the pharynx. Of the symptoms of bilateral dislocation backward nothing positivecan be said. In most of the supposed cases the head has been bentbackward,,the face directed somewhat upward, the tissues of the fron
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