. The principles and practice of surgery. First Position in the Method of Reduction by Manipulation. 332 DISLOCATIONS OF THE FEMUR. the risk of accidents, to lacerate the capsule and the adventitious struc-tures extensively. There is another objection to this extreme flexionwhich my own experience, and the experience of others, has demon-strated ; namely, that it is possible, in this way, to carry the head ofthe bone into the ischiatic notch, and even around the lower edge ofthe acetabulum into the foramen thyroideum. Usually when the thigh is flexed to a right angle, or nearly to a rightangle
. The principles and practice of surgery. First Position in the Method of Reduction by Manipulation. 332 DISLOCATIONS OF THE FEMUR. the risk of accidents, to lacerate the capsule and the adventitious struc-tures extensively. There is another objection to this extreme flexionwhich my own experience, and the experience of others, has demon-strated ; namely, that it is possible, in this way, to carry the head ofthe bone into the ischiatic notch, and even around the lower edge ofthe acetabulum into the foramen thyroideum. Usually when the thigh is flexed to a right angle, or nearly to a rightangle, its progress in this direction is somewhat suddenly arrested; andthis point of resistance determines, in my opinion, the necessity ofchanging the direction. The head of the bone has now descended onthe dorsum of the ilium, and is resting against the abrupt inclinedplane near the upper and outer margin of the acetabulum, ready, atthe next step of the manipulation, to mount this plane and enterthe socket. Fig. Second Position in the Method of Reduction by Manipulation In flexing the thigh upon the abdomen the limb remains adducted,and it is impossible to carry it up abducted; yet the instructionsgiven by Nathan Smith to press slightly against the inner side ofthe knee, so as to cause partial abduction, is judicious, since bythis procedure the head of the femur is made to approach theacetabulum. There is nothing gained by forcible abduction whilemaking the flexion, except in old cases where it is desired to causelaceration; on the contrary, in recent cases it diminishes the chance ofsuccess. Third, the thigh is abducted, and rotated outwards. It is a factworthy of being mentioned, that both the abduction and the outwardrotation often take place spontaneously when the thigh is flexed toa right angle, or, as it was very aptly expressed by one of the old DISLOCATIONS OF THE FEMUR. 333 surgeons, a self-twisting of the thigh occurs, which cannot beprevented by fast holding. Thi
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