Fresh luxations are most easily reduced; those of long continuance are restored with difficulty; but if the head of the humerus adheres to the adjacent parts, which after a long time usually happens, a reduction cannot be effected by any means. See Medical Observations and Inquiries, vol. ii.p. 340.

To reduce the humerus, bend the fore arm, and let an assistant support it; then elevate the arm so that the elbow may be advanced somewhat above the shoulder, bringing it a little inward. An assistant must then make the extension, whilst another counteracting him, draws the inferior angle of the scapula backward toward the spine, and presses the acromion a very little downwards: the operator, with his fingers in the axilla, presses the head of the bone upward as soon as he perceives the extension to be sufficiently made, and at the same time, with his other hand, brings the elbow of the luxated arm to the patient's side. An extension made downwards, or even horizontally, more frequently fails, than when it is made in some degree upward.

When the luxation is forward, that is, when the head of the humerus is under the pectoral muscle, there is a cavity under the acromion, but the head of the luxated bone projects towards the breast more than when in the axilla; and if the arm be moved, a more acute pain is felt than in the preceding case; for the great artery and the nerves of the bones are much pressed. If this luxation is not easily reduced by the method directed, when the head of the humerus is, in the arm pit, let a pulley from the top of a room be fastened to the luxated arm, just above the elbow, and the patient gradually raised from the ground by it: this at least brings the head of the humerus into the axilla, and it may be restored into its proper place by the means just described. In this process the fore arm must be brought toward the breast, that the muscles may be relaxed.

If the luxation is backward, the elbow approaches the chest, and the head of the bone is prominent on the outside of the shoulder; the arm cannot be moved from the breast, nor extended without great agony, and the lower angle of the scapula will be somewhat pushed out. In this case the general process may be the same as when the head of the humerus is under the pectoral muscle.

If there is no pulley, a tall strong man may take the patient's arm over his shoulder, and gently raise him from the ground, and the operator may push the head of the dislocated bone into its place as the body becomes suspended. This method of suspending the patient is not so severe as it may seem; for as no force is used about the shoulder to make a counter extension, the patient does not suffer from those troublesome excoriations and contusions which too commonly attend the other methods.

It is generally agreed that machines for reducing a luxated humerus are never needful. Freke's commander is preferred to all the other instruments used for this purpose; as in the use of it the limb may be moved in all directions during the extension, and the situation of the head of the bone can be examined; but great care is required to keep it perpendicular to the side of the patient.

As in other luxations, bleedings, etc. to prevent or check inflammation and swelling, must be used after the reduction, and the arm suspended by a sling. See Medical Observations and Inquiries, vol. ii. p. 373; Bell's Surgery, vol. vi. p. 211; White's Surgery, p. 158.

14. Manis luxatio. Luxation of the hand. The hand may be luxated backward, forward, and on each side; but a luxation backward or forward is most frequent. Each accident is readily distinguished.

From the distortion of the strong ligament, and the pressure on the tendons, there is exquisite pain and a rigidity of the fingers; and inflammation, tumour, abscess, gangrene, and a caries of the spongy bones of the carpus often follow, seldom curable but by amputation. A recent inconsiderable luxation is more easily managed, and it should be speedily reduced, by extending the hand and arm in opposite directions; and by placing the cavity of the extended hand on a table or some other flat body, that the tumour may be depressed. This method is necessary, whatever part of the hand is luxated. See Luxatio metacahpi, 16.

15. Maxillae inferioris luxatio. Luxation of the lower jaw. This bone is usually luxated forwards on one or both its sides. If one side only is luxated, the chin inclines to the opposite side, and on the dislocated side the mouth is wider open. When both sides are dislocated, the mouth gapes wide, the jaw starts forwards, and the chin falls towards the breast, so that the patient cannot shut his mouth, speak distinctly, nor swallow with ease. This accident may happen from a blow, or from yawning.

When one side only is dislocated, it is easily reduced; but when both sides suffer, the patient must be placed in a low seat, with his head secure against the breast of an assistant; then securing the thumbs from being bit, place them on the patient's teeth, as far back as you conveniently can, at the same time fixing your fingers on the outside of the jaw: when you have secure hold of the jaw, press it downward, backward, and upward. If all this is done almost in the same instant, the reduction will be complete; or, as Mr. Bell says, when the fingers are applied as directed, the surgeon must pull the under jaw forward, till he finds it move somewhat from its situation; and he should then press the jaw forcibly down with his thumbs, and moderately backward with the palms of his hands, when the ends of the bone will immediately slip into their situation.

If only one side is luxated, the same mode will succeed, if the affected side be pressed most forcibly downwards and backwards. Bandages are useless in this case. See Bell's Surgery, vol. vi. p. 189, 190; White's Surgery, p. 155.

16. Metacarpi luxatio. Luxation of the Meta-carfius. See Maxus luxatio.