. A practical treatise on fractures and dislocations. ward from the side of the body; if this is strongly re-sisted the pressure must be steadily maintained until the resistanceyields. The evidence that the movement has accomplished what wasexpected of it is the appearance of greater fulness of the outer deltoidregion ; if this does not appear the attempt will fail. Then, still main-taining the external rotation of the arm and the flexion of the elbow, the ANTERIOR DISLOCATIONS OF THE SHOULDER. 635 surgeon moves the elbow forward, or forward and slightly inward, untilthe arm is nearly horizont
. A practical treatise on fractures and dislocations. ward from the side of the body; if this is strongly re-sisted the pressure must be steadily maintained until the resistanceyields. The evidence that the movement has accomplished what wasexpected of it is the appearance of greater fulness of the outer deltoidregion ; if this does not appear the attempt will fail. Then, still main-taining the external rotation of the arm and the flexion of the elbow, the ANTERIOR DISLOCATIONS OF THE SHOULDER. 635 surgeon moves the elbow forward, or forward and slightly inward, untilthe arm is nearly horizontal ; during this movement the fulness of theouter deltoid region becomes more marked, and at its termination themanoeuvre is completed by rotating the arm inward and bringing thehand to the opposite shoulder. The bone may slip into place duringthe second movement, elevation of the elbow. Direct traction out-ward of the upper end of the bone by a bandage in the axilla is some-times helpful, and I have sometimes found it advantageous to make Fig. Kochers metliod of reduction : 2d movement, elevation of elbovr. (Ceppi.) firm pressure downward at the elbow (traction in the long axis of thearm) during the movement of outward rotation. The method as thus described is applicable to those cases in whichthe displacement is neither very far inward nor low down, in short,to the higher forms of the subcoracoid variety ; and as it depends forits success upon the resistance of the untorn portion of the capsule itwill fail whenever the capsule is very extensively torn. When thedisplacement is far inward or low, traction upon the abducted limbis more likely to succeed. Konig^ modifies it for the lower anterior and subglenoid dislocationsby making traction in abduction, rotating outward, and then adduct-ing. This is practically the same as the method described as tractiondownward and outward and generally known as Lacours method bymanipulation. Farabeuf^ studied Kochers method experimenta
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectfractur, bookyear1912
