DISLOCATION OF THE PATELLA, &c.

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It is as difficult to keep the bone reduced, as it is easy to reduce it,so smooth and oblique are the articular surfaces. Dislocationsof tlie capsular end of the clavicle, or that nearest the shoulder-joint, are much less common. The luxation upwards is the onlyone that ever occurs ; and this is reduced by carrying the shoulderoutwards, putting- a cushion in the axilla, and applying a properbandage, as in fractures of this bone, making the turns ascendfrom the elbow to the shoulder, so as to press the luxated end ofthe bone downward, and keep it in its due situation, at the sametime that the elbow is confined close to the side, and supported ina sling, by which means the shoulder will be kept raised and in-clined outwards.

Dislocation of the Patella or Knee-pan.

This bone may be luxated outwards, or even inwards, when vio-lently pushed in this direction. The dislocation outwards is themost frequent.

The generality of cases of this description are easily reducedby pressure, when the extensor muscles of the leg have beencompletely relaxed ; but owing to a lax state of the ligament ofthe patella, or other predisposing causes, the bone is sometimeswith difficulty retained in its proper position, unless a roller be ap-plied.

The inflammatory affection of the joint is to be opposed by top-ical bleeding, purging, and the use of evaporating lotions. Thejoint must be kept quiet a few days, and then gently moved, toprevent stiffness.

Dislocation of the thigh.

The head of the thigh-bone may be dislocated upwards (on thedorsum of the ilium,) upwards and forwards (on the body of the o:pubis,) downwards and forwards (on the foramen ovale,) andbackwards (on the ischiatic notch). The dislocation upward andbackward, and that downward and forward, are the most frequent.

When the thigh-bone is dislocated forward and downward, theknee and foot are turned out, and the leg is longer than the other ;but when it is displaced backward, it is usually pushed upwards atthe same time, by which means the limb is shortened, and the footis turned inwards.

When the thigh-bone is displaced forward and downward, thepatient, in order to have it reduced, must be laid upon his back,and made fast by bandages, or held by assistants, while by othersa gradual and unremitting extension is made by means of slings,or a pulley fixed about the bottom of the thigh a little above theknee ; a sheet, folded longitudinally, being first placed under theperinasum or fork, and one end carried behind the patient, the oth-er before him : they are to be fastened to one of the legs or postsof the bed, or other more secure part. While the extension ismaking, the operator must push the head of the bone outward, oí-as the circumstances of the case may require, till it gets into thesocket. If the dislocation be outward, the patient must be laid