De Medicina

21 It is very well known that the knee is put out externally and internally and backwards. Many have written that it does not slip out forwards; and this may be very near the truth, for the knee-cap

22 The ankle can be dislocated in all fought directions. When it slips inwards, the sole of the foot is turned outwards; when outwards, the contrary sign is exhibited. If the ankle is dislocated forwards, the broad sinew behind is hard and tense, and in those cases manipulation is required; if backwards, the heel is almost hidden and the sole is elongated. But this is also replaced by manipulation, the foot and leg first being stretched in opposite directions. And after this kind of accident also, the patient should stay for a long while in because, lest the ankle, which sustains the whole weight of the body, should give way and again be displaced if the sinews have not gained strength enough for bearing the weight. At first low shoes should be worn, so that the ankle may not be injured by tight lacing.

23 The bones of the sole of the foot may come out like those of the hand, and are set after the same fashion. Only the bandage should also include the

24 For the toes the same treatment is required as was laid down for the fingers. But the middle or end joint when replaced may be fixed in some kind of gutter splint.

25 This is the treatment for those cases in which no wound accompanies the dislocation. . . . In these cases too there is not only great danger but it is more serious, the larger the limb, and the more powerful the sinews and muscles controlling it. Hence in the case of the shoulder and hip joints there is risk of death: and if the bones are set, there is no hope at all; if not, there is still some danger, and in either case the nearer the wound is to the joint the greater the cause for anxiety. Hippocrates said that no such dislocation could be replaced safely except those of fingers and toes, and feet and hands, and even in these cases it was best not to be in a hurry. Some have also replaced elbows and knees; and have then let blood at the elbow, lest gangrene and spasm should arise, after which generally in such cases an early death follows. Even a finger, in which the damage and therefore the damage is least, ought not to be reset whilst there is inflammation, or indeed at a later stage when the condition is of long standing. Moreover, when after replacement the sinews become tense, the bone should at once be put out again. Where there is a dislocation and a wound as well, the limb which has not been seet should lie in the position easiest