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Dislocation of the Knee-pan.Yet, notwithstanding this fact-that the knee-pan is not bound directly to the thigh-bone - it is not very frequently dislocated. It may, however, be displaced by direct violence, such as a fall upon the knee ; it sometimes is dislocated also by the sudden contraction of the muscles which are attached to its upper border. The knee-pan may be dislocated either outward or inward or upward ; or it may be turned upon its edge, so that one border of it rests upon the end of the thigh-bone, while the other projects under the skin. The most common displacement is toward the outer side of the leg. Signs.-This outward dislocation can be recognized by the change in the form of the knee ; the front of the knee seems flattened, while the knee-pan itself can usually be seen on the outer side of the limb. This dislocation is accompanied by a loss of motion in the leg, the patient being unable to bend the knee. The outward dislocation of the knee-pan is met with more frequently in women than in men. This results from the peculiar obliquity of the thighs in females; for, in consequence of the greater breadth of the hips in women, the thighs are directed somewhat obliquely inward, and a violent contraction of the muscles has a natural tendency, therefore, to displace the knee-pan toward the outer side of the limb. A dislocation of the knee-pan toward the inner side of the limb is accompanied by essentially the same symptoms ; the form of the knee is somewhat different, since the prominence of the knee-pan is now observed on the inner side of the limb. That form of dislocation of the knee-pan in which the bone rests edgewise, is extremely rare. It can be readily recognized by the peculiar shape of the knee, which now presents a sharp edge instead of its usual flat surface. In a few exceptional cases the knee-pan has been turned completely over, so that the surface which ordinarily rests upon the thigh-bone lies directly under the skin. Treatment. - In treating an outward dislocation of the knee-pan, the patient rests upon his back upon the floor ; the leg is straightened and the foot raised. The operator stands facing the patient and places the heel of the injured limb upon his shoulder; he then pushes strongly upon the displaced bone, so as to force it back into its former position. An inward dislocation is treated in essentially the same manner. A dislocation of the knee-pan upward results from a rupture of the ligament or sinew which binds the little bone to the large bone of the leg, called the tibia. The knee-pan can be readily pulled back into its place, but slips up ag2in as soon as the pressure is removed, because the muscle which is attached to its upper border pulls it upward onto the thigh. The treatment of this dislocation consists, therefore, in measures which shall overcome the contraction of this muscle and hold the knee-pan in place until the tendon which unites it to the leg has healed again. This requires the application of a dressing similar to that which is employed in fractures of the knee-pan. For a discussion of these the reader is referred to the chapter on this latter subject. The ligament heals after the lapse of seven or eight weeks, and the patient regains the use of the limb. He should, however, be careful not to subject the leg to any strain for several months subsequently ; it is advisable for him to wear a strong elastic band over the knee which shall assist in holding the knee-pan in position. In many cases the ligament which joins the knee-pan to the tibia is longer than natural and the movement of the limb is consequently somewhat though not seriously impaired. In treating a dislocation of the knee-pan in which the bone lies edgewise on the front of the leg, the patient should be placed upon his back, as before, the heel of his injured limb resting upon the shoulder of the operator. The surgeon then presses in one direction with one hand upon the upper border of the bone, while pressure is made in the opposite direction against the lower border by means of a large doorkey or some similar instrument. In most cases several efforts must be made before the bone is restored to its proper position ; the reduction may be assisted by bending and straightening the leg several times while the pressure upon the edges of the knee-pan is continued. The difficulty lies, of course, in the contraction of the large muscle to which the knee-pan is attached. In order to overcome this an assistant may make firm pressure downward - that is, toward the knee - by spreading both hands over the front of the thigh a few inches above the knee-joint. In all dislocations of the knee-pan, the joint becomes much swollen. In the more favorable cases this swelling subsides in a few days under the use of hot fomentations ; but in some instances a serious inflammation, which may materially injure the structures composing the knee-joint, occurs. In every case the manipulations should be conducted as gently as possible, and hot fomentations should be assiduously applied to the knee. The limb should be laid upon a splint of wood extending from the hip to the ankle, and fastened by means of a bandage applied to the leg and to the thigh. Dislocations of the knee-pan are apt to recur upon slight provocation. It is therefore advisable for the patient to wear a rubber or leather bandage around the knee for some months subsequent to the injury, and to take every precaution in avoiding severe strains upon the limb. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! 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