More or less inflammation occasionally super venes to luxation, and its necessary reduction, and may require local and general blood-letting, fornen tations, local irritants, low diet, cathartics and con finement to bed. The arm should be kept quiet for at least three weeks, to permit the lacerated capsular ligament and muscles to heal, and after wards passive motion allowed; hut the patient ought to be cautioned against lifting his arm with too much freedom, as this luxation is extremely liable to be reproduced. Emphysema, ecchymosis, rupture of the axillary artery, and large abscesses have occurred from reduction. Reduction of this luxation may be attempted during any period with in three months; but some have succeeded at the distance of ten months; much, however, must de pend on the constitution and violence of the injury, for inflammation, mortification and death have fol lowed attempts at reduction beyond three months. In old luxations, a warm bath should be used im mediately before reduction is attempted.
If the head of the os brachii is not reduced, but pulled up by the muscles towards the clavicle, it is then termed a consecutive luxation, a form of the disease said by Sir A. Cooper to be primary. Larrey relates a luxation, where the head of the os brachii was wedged between the second and third ribs. The head of the os brachii now forms a new joint, the inflammation induced consolidates the muscles and cellular substance, which form a cartilaginous bed and a rude capsule, the loose mus cles around contract and become rigid, and accom modate themselves to their new functions; the old capsular ligament heals up and the glenoid cavity is filled up with a soft gelatinous adhesive substance. Compound luxation of this joint seldom or never occurs; dislocation, however, with fracture of the neck of the os brachii, fracture of the acromion scapulae, or fracture of the cervix scapuLe some times takes place; and each of these fractures oc casionally present themselves without the luxation, so that we ought to be careful in distinguishing between them.
Compound luxation occurs probably more fre quently at the ankle joint than at any of the others: this consists in a protrusion of either the tibia singly, or tibia and fibula combined, through the skin, and the foot hangs loosely on either side of the leg. Compound luxation also comprehends the injury of the integuments and soft coverings, and the exposing or the bones of the joint to the exter nal air. In such cases, if the bone cannot be re duced within the soft parts, it ought to be sawn oil'; or the practitioner must take into considera tion amputation of the limb; for our own parts, we are disposed to prefer amputation, to the tedium of suppuration, exfoliation, and partial anchylosis, at the imminent hazard of the patient's life, conse quent on the violent constitutional and hectic fever, gangrene, or tetanus during the cure. If an at tempt be made to save the limb, the wounded arte ries are to be secured, as many pieces of bone should be gently removed as can be done with fa cility and promptitude, the protruded bone washed, and either reduced or sawn off, the wound approx imated by adhesive straps and suture, and covered with dry lint, and laid on a soft pillow or placed in M'Intyre's fracture-splint. Considerable inflamma
tion, together with suppuration, generally follows, and requires most active antiphlogistic treatment. Simple luxation of the ankle joint may be mistaken for fracture of the tibia into the joint, and for a sprain of the tendons in this region.
Sprains consist in the laceration of the vaginal ligaments or sheaths of the tendons of muscles producing an effusion of lymph in the contiguous cellular tissue, and occur most frequently on the back of the hand; they also affect the muscles themselves by overstretching and slightly lacera ting their fibres. In sprains, there is almost im mediate discolouration, but no tumefaction until some time after the accident, which is generally only on one side of the joint, but occasionally on both. Sprains are treated first with leeches and warm anodyne applications, and secondly with stimulating liniments, friction and bandage. Gan glions or ganglia are either the result of sprains or bruises, and consist of an effusion of lymph, or the mucous secretion of the sheaths of the tendons; they appear in the form of a circumscribed, movea ble, elastic tumour, free of pain, but frequently in commoding the individual in the motions of the parts, particularly if situated on the foot. They should be treated with pressure and bandage, and if these fail, with extirpation of the entire cyst. Sir A. Cooper recommends striking them a smart blow with a book, in order to rupture the cyst, and diffuse the glairy fluid into the cellular tissue that it may be absorbed.
Besides luxation, the joints are subject to many diseases, to inflammation, synovial and serous effu sion, suppuration, ulceration, anchylosis, and loose cartilages floating in them. Inflammation has been already noticed under luxation, and which may be produced by the same causes as those that excite it on ordinary occasions, and the treatment re quires to be extremely active, both locally and con stitutionally, according to the magnitude of the joint and the severity of the injury. When the knee joint is very slightly inflamed from an ex posure to cold, the synovial membrane secretes more synovial fluid than in health; and if the in flammation be a little more severe, this fluid be comes more watery, occasionally pure serum or dropsy, which constitutes hydrops arlieuli. From this view, it will be seen, that dropsy is an over abundant effusion of the serous portion of the blood, dependent either upon increased secretion of the exhalants, or on diminished absorption, or on a combination of both. This termination is still better illustrated in the serous cavities of the brain, thorax, or abdomen. If all inflammatory action has abated, the effused fluid into a joint may be discussed with a succession of blisters, compress and bandage, and if these fall, it should be evacua ted by a valvular opening made with a bistoury on the outside of the joint between the patella and ex ternal condyle of the os lemoris. This dropsical effusion is occasionally confined to the bursa under the patellar ligament, and then presents a globular swelling; but when it attacks the bursa under the crumus muscle it invariably communicates with the joint.