Frank Hastings Hamilton.

A practical treatise on fractures and dislocations online

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and greatly varied, so as to suit all the changing circumstances in the
condition of the patient.

Finally, if after a fair trial we fail to accomplish a cure, or if the
condition of the child will not warrant even the attempt, we ought as
far as possible to seek to prevent an increase of the deformity by
such means as our ingenuity may suggest, or by such judicious appli-
ances and general management as we have seen recommended by

South says that he has seen one case of double dislocation in which
the walking was at first extremely diflScult, but from the fifteenth
year and onwards the patient so improved, that at the twentieth year
scarcely any trace of the peculiar gait could be discovered.*

§ 14. Congenital Dislocations or the Patella.

Falletta found a dislocation of the patella in the cadaver of a young
man, which he supposed to be congenital.^ Michaelis has reported
two cases ; one in a young man of seventeen years, and the other in
a girl of fourteen, each of whom afiSrmed that it had existed from
birth.* Both of these examples presented themselves at the hospital
on account of hydrarthrosis of the knee-joints, and Malgaigne, who
had himself seen a similar case, is disposed to regard them all as
examples of pathological rather than congenital luxationa P^riat

» Gu^rin, op. cit., pp. 81-8.

« South, Note to Chelius, op. cit., vol. ii. p. 245.

* Palletta, Exercitationes Pathologic®, p. 91.

* MichaeliF, Rev. H6d.-Chirurg., torn. zv. p. 56.

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reports a case in which the dislocation was only produced by walk-
ing, and in relation to the authenticity or pertinence of which Mal-
gaigne seems also to entertain a doubt.^

South says that he has seen a congenital dislocation on both legs,
in an aged man. The patellas rested entirely upon the outer faces of
the external condyles, leaving the front of the knee-joint completely
uncovered. When the limbs were extended the patellss could be
easily made to resume their natural positions, but on the patient's
making the slightest movement they were again displaced. The
knees were very much inclined inwards, the feet outwards, and his
gait was difficult and unsteady.'

Dr. Saml. G. Wolcott of Utica, N. Y., informs me that he has under
observation a case similar to the one reported by South, in a healthy
and otherwise well formed and well developed boy, aet. 4. " When
the legs are flexed the patellae slip outwards upon the external con-
dyles of the femurs, and on extending the legs the patellae resume
their positions in front of the knee-joints. This occurs at every step
he takes. The knees are strongly inclined inwards, and the feet out-
ward. His step is very insecure, and if accidentally he hits his feet or
legs against anything in walking, he invariably falls."

The most remarkable example, however, has been reported by Dr.
E. J. Caswell, of Providence, R. I., inasmuch as no less than five
members of the same family have double congenital dislocations of
the patellae. The man who was the subject of Dr. Caswell's special
examination is 48 years old, and possessed of a good constitution.
The patellae lay upon the outer condyles, and are movable, performing
their functions nearly as well as if placed in their proper positions.
He walks without difficulty upon level ground, or upon an ascending
plane, but great caution is required in descending. The right patella
is longer and less movable than the left, and the muscles of both of
his lower extremities are small. "In addition to his labor as an
operative, he cultivates a small farm." Dr. Caswell examined his
son and found the same malposition, but less marked than in the case
of the father. The father then stated that his own father, his sister,
and the son of his half brother by the same father, had a similar de-

§ 15. Congenital Dislocations of the Knee.

The head of the tibia has been found, at birth, dislocated forwards,
backwards, inwards, outwards, inwards and backwards, outwards and
backwards, and simply rotated inwards.

Most of these luxations were incomplete ; and of them all, the dis-
location forwards has been observed much the most often.

A subluxation forwards of the head of the tibia has been seen by
Gudrin in a foetal monster, accompanied with extreme retraction of

• P^riat, Malgaigne, op. cit., torn. ii. p. 982.

« South, Note to Chelius, op. dt., vol. il. p. 247.

• Caswell, Amer. Joum. Med. Sci., July, 1863.

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the extensor muscles of the Ieg.\ Cruveilhier has dissected a foetus
affected with a similar subluxation.^

In these examples the displacement forwards at the articular surface
was but slight; and the anterior flexion of the limb inconsiderable;
but when the dislocation is complete, or nearly so, the deformity \s
in all respects very much increased ; as the following examples will
illustrate: —

Dr. D. H. Bard, of Troy, Vermont, has reported an example of
complete anterior luxation of the tibia, seen by himself, in a new-bom
infant. The leg was found drawn forwards upon the thigh at an acute
angle, so tliat the toes pointed toward the face of the child, and the
bottom of the foot was directed forwards. By the application of
moderate force, the limb could be straightened and even flexed com-
pletely. These motions inflicted no pain. It was especially noticed
that in bringing down the leg from its position of extreme anterior
flexion (extension) more force was required in the first part of the
manoeuvre than in the last ; and that if, having brought the leg down,
it was left to itself, it immediately resumed the abnormal position,
moving at first slowly, but after a time much more rapidly.

The limb was confined by bandages for a short time, and it did not
afterwards show any disposition to return to its unnatural position.
The child did well, and when it began to use its legs, no difference
could be discovered between them.'

J. Youmans, of Portageville, N. Y., reports a similar case which
occurred in his own practice. A healthy woman was delivered, on the
1 6th of Aug. 1859, of a full grown female child, whose left knee was
so completely dislocated that the toes rested upon the anterior part of
the thigh near the groin. Dr. Youmans immediately took hold of
the limb and brought it to its natural foi^m, but as soon as he relin-
quished his hold, it flew back to its original position. Having again
straightened the leg it was retained in place easily by two pieces of
whalebone tied upon each side of the thigh and body. Some soreness
and swelling ensued, and it was some weeks before the splint could
be safely removed. At the time of the report, Oct. 11, 1860, the child
was using the limb with as much freedom and dexterity as other
children of her own ag.e.

In the report particular attention is called to the disposition on the
part of the limb to resume its unnatural position with a spring, show-
ing contraction of the anterior muscles of the thigh ; to the fact that
the patella of this knee was smaller than the other, and that the skin
on the front of the knee was wrinkled as it is usually back of the
knee in fat children.*

I have mentioned a case of congenital forward dislocation of both
tibiae which came under my observation, in the section on congenital
dislocations of the hip, and I have recently seen a case of congenital

» Gu^rin, op. dt., p. 83.

« Cruveilhier, Atlas de TAnat. Patholog., 2e livr., pi. 3.

> Bard, Amer. Joum. Med. Sci., Feb. 1835, p. 555, from Boat. Med. and Stag.
Joum. Nov. 28, 1834.
* Youmans, Bost. Med. and Surg. Joum., Oct. 25, 1860, vol. 63, p. 250.

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siibluxation of both tibiaa backwards, occasioned by contraction of the
liamstrings. Section of the muscles restored the bones nearly to their
i:iormal position.

Chatelain was consulted in relation to a similar case, in which the
restoration of the limb to its natural position was also easily effected,
and by means of three metallic splints, applied during about fifteen
days, the cure was consummated. Chatelain directed, however, that
the leg should be kept flexed upon the thigh eight days longer.^

Kleeberg found a child with the leg so much flexed forwards (ex-
tended) upon the thigh that the popliteal region became the lowest
point of the limb; in front and above the articular extremity of the
tibia could be felt, and the condyles of the femur made a correspond-
ing projection behind into the popliteal space. This was plainly an
example of complete luxation; and, contrary to what was observed
in Bard's case, flexion of the limb backwards was difficult and painful.

The treatment was commenced by securing the limb in a straight
position by means of a splint and roller ; subsequently, Kleeberg car-
ried the limb back to an obtuse angle, and finally, it was kept eight
days in a position of extreme flexion. A complete cure was said to
have been accomplished in about two weeks.'

Gu^rin has seen a subluxation backwards, accompanied with a slight
rotation of the head of the tibia outwards, in a girl fourteen years old;
and which, he affirms, was congenital, characterized by a permanent
flexion (backwards) of the leg upon the thigh, and a sliding of the
condyles of the tibia backwards.

This girl was under Gudrin's treatment, but with what result is not

Chaussier found both tibiaa displaced backwards in an infant other-
wise deformed.*

Robert speaks of an example of lateral subluxation in a man, which
had existed from birth. The right knee was thrown inwards, and the
left outwards."

Gu^rin ''operated" publicly upon a child, two years old, who had a
congenital dislocation of the head of the tibia backwards and inwards,
accompanied with a slight rotation of the leg inwards.* In what man-
ner he operated, and with what result, he does not inform us.

The same writer speaks of a subluxation backwards and outwards,
with rotation in the same direction, a deformity which, he affirms, is
very frequent, and which appears especially after birth, although the
causes which produce it have given their first impulse during intra-
uterine life.

The case quoted from Robert, by Malgaigne, as an example of dis-
location inwards, seems to have been rather a case of semi-rotation
of the articular surfaces, the inner condyle being thrown back into
the popliteal space, while the outer condyle still retained its natural

1 Chatelain, Bibliotheque M^., torn. Ixzy. p. 85.

« Kleeberg, Malgaigne, op. cit., p. 988. * Robert, Malg., op. cit., p. 085.

' Qu^rin, 8ur les Lux. Congen., p. 38. « Querin, sur les Lux. Congen., p. 83.

* Chaussier, Malgaigne, op. cit., p. 881.

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Under this general term may be included all those varieties of snb-
laxation of the several bones which compose the tarsus, and which are
known as examples of talipes or club-foot; such as tibio-astragaloid
luxations, astragalo-scaphoia,calcaneo-astragaloid, calcaneo-cuboid, &c.

Although these deformities may properly enough claim a place in
a chapter on congenital dislocations, they have so long been the sub-
jects of special treatises as to justify their exclusion from the present

§ 17. Congenital Dislocations of the Toes.

Observed occasionally at the metatarso-phalangeal articulations; the
articular facets of the first phalanges suffering a subluxation upwards,
or laterally upon the corresponding metatarsal bones.

Gudrin has noticed especially a congenital lateral subluxation of
the great toe.*

' Gu^rin, op. clt., p. 34.

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Abscess in frsotnre of the Bternnm, 169
Aoetabulam, 343
Aoromion process, 208
Amesbary's thigh splint, 309
AnsBsthetics, nse of, in diagnosis, 37
Anatomical neck of hnmerus, 215
Anaplasty in fractures of the septam nariam, 96
Anchylosis after CoIIes's fraotare, 282

after fractures of elbow, 266

excision for anchylosis of knee, 444
Apparatus immobile; 54

in fractures of the leg, 463
Arytenoid cartilages, fractures of, 130
Ashhurst, fracture of astragalus, 478
Astragalus, 476
Atlas, 164

and axis, 164
Axis, 161
Ayrefl, compound fracture of olaviole, 187

Badly united fracture of leg, 474
Bartlett*s apparatus for broken clavicle, 198
Bartends bran dressing, 61, 473

bandage for fractured jaw, 129

trephining vertebrsB, 148

fracture of lower end of radius, 28]
Base of acetabulum, 344
Bauer's wire splints, 471
Beans, lower jaw, 124
Bending of bones, 72
Biceps, displacement of long head, 576

rupture of, 576
Bigelow, stellate fracture of lower end of ra-
dius, 279

rim of acetabulum, 345
Boardman, fracture of sygoma, 107
Body of the scapula, 202
Bodies of the vertebras, 151
Bond's elbow splint, 251

radius splint, 285
Bosworth, Frank, tracheotomy in fracture of

lower jaw, 110
Box for leg, 473
Boyer's thigh splint, 399
Brainard, perforator, 70
Buck, lower jaw, 119

thigh splint, 407
Bnrge, patella, 443

Calcahiuit, 477
Carpal bones. 327
Cartilages, 177

Carved splints, radius, 291
Cervical ligaments, strains of, 157

vertebrsB, bodies of five lower, 155

axis, 161

atlas, 163

atlas and axis, 164
Children, fracture of femur, 426
Chronic rheumatic arthritis, 367
Clark's case of fracture of pelvis, 337
Clark, fracture of humerus, 239
Clavicle, 178

partial fractures, 179

repair of fractures, 185
Cline, trephining vertebrsB, 148

fracture of atlas, 164
Coates, fracture bed, 418

bran dressings, 61
Coccyx, 351
Colles's fracture, 274
Comminuted fractures, 60
Common signs of fracture, 33
Compound fractures, 60

forearm, 327

thigh, Gilbert on, 408

thigh, author's opinion, 428

patella, 438

tibia and fibula, 464
Concussion of spinal marrow, 157
Condyles of humerus, 256
internal, 261
external, 263
base, 245
base and between condyles, 253

of femur, 428
externa], 428
internal, 429
base. 431

between condyles, 431
Congenital, 31, 234, 445
Cooper, Sir Astley, fracture of olecranon pro-
cess, 315

neck of femur within capsule, 361

patella, 441
Coracoid process, 211
Coronoid process of ulna, 301
Cotyloid cavity, 343

Counter-extension by adhesive plaster, 408
Cradle for leg, 472

Crandall, extension, fracture of leg, 469
Cricoid cartilage, 138, 140
Crosby, neck of femur within capsule, 371

external epndyle, 428

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Daniels' fraotnre-bed, 419
DeformitieB of legs, 474
Delayed or n on -union, 62

humeras, 234

tibia, 470
Dextrine, 55
Diagnosis, general, 33
Dieffenbach, tenotomy in fraotnre of olecranon

process, 317
Dislocation of humerus, differential diagnosis,

Division of fractures, general, 27
Dorsal vertebra), 154
Dorsey, fracture of patella, 440
Dugas, sign of dislocation of humerus, 228
Dupuy trends case of fracture of a dorsal ver-
tebra, 155

body of a lower cervical vertebra, 156

dressing for fhicfcure of fibula, 451

Elbow splint, Physiek's, 249

Kirkbride's, 250

Rose's, 250

Welch's, 250

Bond's, 251

the author's, 252
Else, fracture of axis, 161
Emphysema in fracture of ribs, 175
Epicondyle of humerus, external, 260

internal, 256
Epiphyseal separations, 28

acromion, 208

humerus, upper end, 221
lower end, 245

femur, upper end, 356
lower end, 433

trochanter mi^or, 384
Epiphyses, sternum, 167

scapula, 210

humerus, 222

radius, 296

ulna, 305

08 innominatnm, 335

femur, 352

tibia, 445

fibula, 449
Epitrochlea, 256
Etiology, general, 29
Eve, non-union of ribs, 174

patella, 435
Exciting causes, general, 29
Experiments on bending, 73

on partial fractures, 78, 82
External epicondyle of humerus, 260

condyle of humerus, 263
femur, 428
Extension of thigh by adhesive plaster, 417

Fanninq, N., humerus, 233
Fauger, GoUes's fracture, 285
Felt splints, 61
Femur, 352

neck, within capsule, 353

neck, anatomy of, George K. Smith, 365

differential diagnosis, 357

without capsule, 376

trochanter mi^or and base of neck, 383

epiphysis of trochanter major, 384

shaft, 386

in children, 426

external condyle, 428

internal condyle, 429

Femur —

between condyles, 431

hate of condyles, 431

separation of lower epiphysis, 433
Fibula, 449
Fingers, 331
Fissures, 84

neck of femur, 352
Fitch, fracture of iDwer jaw, 129
Flagg's thigh apparatus, 405
Floating cartilages, in knee-joint, 700
Forearm, 318

Fore's case of fracture of hyoid bone, 134
Four-tailed bandage for broken jaw, 130
Fracture beds, 416

Jenks, 431

Hewson, 416

Barton, 418

Goates, 418

Daniels, 419

Burges, 411

Grosby, 421
Fraoture-box, 473

Gangrene, after fracture at base of condyles
of humerus, 249

Dupuytren's cases after fracture of radios,

Robert Smith's cases, 293

Norris, 294

after fracture of forearm. 320

leg, from tight roller, 412

patella, 441

from tight bandages, 448

leg from tight bandages, 461

from use of "apparatus immobile," 464
Gibson, bandage for fractured jaw, 129

fracture of clavicle, 188
of eoraooid process, 211
Gilbert, apparatus for broken femur, 416

leg. 468
Glenoid cavity of scapula, comminuted, S07
Granger, fracture of epicondyle, 256
Greater tubercle of humerus, 219
Gunning's interdental splint, 124
Gunshot fractures, 483

treatment in, 486
Gutta-percha splints, 52

Harris, separation of upper maxillary bones,

Harrold, lumbar vertebrae, 154
Hartehorne, Edward, clavicle, 193
Hartshome, Joseph E., thigh apparatus, 403
Hays, radial splint, 285
Hayward, lower jaw, 120
Head of femur, 353

of radius, 270

and anatomical neck of humerus. 215

and neck of humerus, longitudinal frac-
ture, 219
Hewson, fracture-bed, 418
Hodge, thigh-splint, 416
Hodgen's fracture-cradle, 487

'* wire, suspension splint, 403
Hodges, head of radius, 470
Horner, thigh apparatus, 407
Humerus, 213

anatomical neck, 215

head and neck, 215-219

tubercles, 219

longitudinal fracture of head and neck, 319

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Snineras —

surgical neck, 221

upper epiphysis, 221

differential diagnosis, 227

shaft, 234

lower epiphysis, 245

base of condyles, 245

with splitting of condyles, 253

condyles, 256

internal epicondyle, 256

external epicondyle, 260

internal condyle, 261

external condyle, 263

delayed union, 266

dislocation of, 228
Sntchinson, leg splint, 467
Hatchinson, J. 0., fracture of spine, 149
Hyoid bone, 133

Iliuv, 340

Immovable apparatus, 54

leg, 463
Impacted fractures, 28

head and neck of humerus, 215

tubercles, 219

neck of femur within capsule, 355
without the capsule, 377
Incomplete fractures, 72
Inferior maxilla, 109

Interstitial absorption of neck of femur, 367
Internal condyle of humerus, 261

femur, 429
Interdental splints, 122
Intra-uterine fracture, 35, 235, 445

fracture of tibia, 445
Ischium, 398

Jacksoit, acromion process, 209
Jarvis's adjuster, 467
Jenks, fracture-bed, 431
Johnson, neck of femur, 364

Key, lumbar yertebrss, 154
Eingsley, fracture of lower jaw, 128
Kirkbride, elbow splint, 250

Larynx, fracture of, 138

Lausdale, patella, 444

Lente, fracture of dorsal vertebra, 155

femur, 410

non-union, 67

pelvis, 335
Lewitt, patella, 439
Listen, thigh splint, 396

leg splint, 471
Lockwood, fracture of humerus at birth, 234
Long head of biceps, displacement of, 576
Long splints, 48
Lonsdale, extension in fracture of humerus, 237

patella, 442
Lower jaw, 109

Malar bone, 97

McDowell, remarkable displacement of head
of humerus, 215

separation of upper epiphysis, 223
Malgaigne, apparatus for fracture of leg, 473
Many-teiled bandage, 47
March, acromial separations, 209
Martin, fracture of humerus, 238
Maxilla, superior, 100

inferior, 109

Metacarpus, 328

Metatarsus, 481

Metallic splinte, 48

Monahan, fracture of astragalus, 476

Moore, GoUes' fracture, 280

fracture of clavicle, 195
Morbus cox» senilis, 367
Morland, statistics of fracture of tibia and

flhula, 455
Mott, prognosis in Colles* fracture, 288

electricity in non-union, 67
Mussey, fracture of coracoid process, 211
Mutter's "clamp," 123

neck of radius, 270

Neck of femur, 353

within capsule, 358

prognosis, 361

G. K. Smith on, 365

without capsule, 376
Neck of humerus, anatomical, 215

surgical neck, 221
Neck of lower jaw, 111
Neck of radius, 267
Neck of scapula, 206

signs of fracture, 228
Neill, maxilla superior, 105

coracoid process, 211
thigh, 404

leg, simple fracture, 467
compound fracture, 468
N6laton, radial splint, 285
Non-union, 62

humerus, 240

lower jaw, 117

ribs. 173
Norris, delayed and non>nnion, 02

astragalus, 479

gangrene from bandages, 294

tibia, 448
Nose, fracture of, 89
Nott. wire splints, 48

thigh apparatus, 401

Odontoid process of axis, 161
Olecranon process, 310

tenotomy, 317
Ossa nasi, 89

Packard, J. A., clavicle, 193

Palmer's thigh splint, 402

Partial fracture, 76

Patella, 434

Pelvis, 334

Phalanges of fingers, 331

toes, 482
Pubes, 335

Radius, 267

Radius and ulna, 318

Reduction of fractures : general considera

tions, 44
Refracture of badly-united legs, 474
Repair of fracture, 38
Resection for badly united fractures, 474
Rheumatic arthritis, chronic, 367
Rhinoplasty, 96
Ribs, 172

cartilages of, 177
Rim of acetabulum, 347
Rodet, neck of femur, 354
Rogers, trephining vertebrss, 149

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Ron«r, 46

Rose, elbow splint, 350

Sacbuv, 349

Baoro-ilUo symphysis, 335

Salter's oradle for leg, 477

Sargent, separation of upper maxillary bones,

Sayre, L. A., olaviele, 196
Soapala, 202

body, 202

neok, 206

acromion process, 208

ooracoid process, 211

epiphyses of, 210
Scnltetus, bandage, 46
Semeiology, general, 33
Septum narium, 94
Setting bones, 44
Sentin, dressing, 54
Shaft of humerus, 234

radius, 271

ulna, 297

femur, 386
Shoulder-joint ; differential diagnosis of acci-
dents, 227
Bhrady, radius splint, 286
Side splints, 48
Sling for broken jaw, 130
Smith, E. P., radial splint, 286
Smith, Nathan R., fracture of femur, 402
Smith, Robert, head of humerus, 217
Smith, Stephen, fracture of lower jaw, 116

odontoid process of axis, 164
Smith, Geo. K., insertion of capsule of hip-
joint, Ac., 365
Spinal marrow, concussion, 157
Spinous processes : rertebrsB, 142

Uium, 340
Splints, 48
Starch bandage, 54
Sternum, 165

Stone, base of condyles and resection, 255
Styloid process of radius, 280
Surgical neck of humerus, 221, 230, 232
Swing box for leg, 472
Symphyses of pelvis, 334

pubes, 335

sacro-iliac, 350
Symphysis pubis, separation of, 334

Tarsus, 476

astragalus, 476

calcanenm, 477
Tenotomy in fractures of olecranon process, 317

Thompson, fracture of lumbar Tertebre, 153

Thyroid cartilage, 138

Thyroid and cricoid cartilages, 138

Tibia, 444

Tibia and fibula, 453

Toes, 482

Transverse processes of spine, 144

Treatment of fractures, general, 44

Trephining for fracture of Tertcbrs, 148

Trochanter mi^or, 383

Trochlea of humerus, 361

Tubercles of humerus, 219, 229, 231

ITlva, resection of, 295
inna, 297

shaft, 297

eoronoid process, 301

olecranon process, 310
Upper epiphysis, humerus, 221

femur, 356
Upper maxillary bones, 100

Vandbrtsib, fracture in utero, 33
YandeFenter, fracture of Tertebrml arch, 146
Velpeau, mode of dressing fractures with dex-
trine and rollers, 55
Vertebral arches, 145
Vertebras, 142

spinous processes, 142
transverse processes, 144
vertebral arches, 145
bodies, 151

lumbar, 153
dorsal, 154
cervical, 155
axis, 161
atlas, 163
atlas and axis, 164

Warrbn on anchylosis at elbow-joint, 266

Water-beds, 160

Watson, fracture of lower jaw. 111

lower epiphysis of humerus, 245

patella, 437
Weber, plaster of Paris bandage, 59
Wells, internal condyle of femur, 429
Whittaker, pelvis, 338
Wire-beds, 160
Wire splints, 48

Wire rack for fracture of leg, 473
Wood, fracture of patella, 440
Wooden splints, 49
Wrist, 327

ZrooMATic arch, 106

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Ancient lazAtions, 404

inferior maxilla, 604

apine, 612

olaTiele, onter end, 634

hnmems, 560

head of radioB forwards, 581

radios and ulna backwards, 601

thnmb, 020

femnr, 686
Andrews, inferior maxilla, 602
Ankle-joint, 713
Anomalons dislocations of the hip, 678. See


Online LibraryFrank Hastings HamiltonA practical treatise on fractures and dislocations → online text (page 91 of 100)