).]

#Dislocation on to the pubes# is a further degree of the obturator
form (Fig. 71). It is usually produced by forcible hyper-extension and
lateral rotation of the hip, such as occurs when the body is bent back
while the thigh remains fixed.

The capsule is torn farther forward than in the other varieties, and
the head rests on the horizontal ramus of the pubes against the
ilio-pectineal line.

_Clinical Features._--There is marked eversion, flexion, and
abduction, but the shortening is inconsiderable. The ilio-psoas and
[inverted Y]-ligament are tense. The head of the femur may be felt in
the groin, with the femoral vessels over, or to one or other side of
it. There is sometimes pain and numbness in the distribution of the
femoral (anterior crural) nerve. The prominence of the great
trochanter is lost.

#Treatment of Dislocation of the Hip.#--For the reduction of a
dislocation of the hip complete anaesthesia is necessary, and the
patient should be placed on a firm mattress on the floor to give the
surgeon the best possible purchase upon the limb. The surgeon grasps
the ankle with one hand, while the other is placed behind the head of
the tibia, the leg being held at right angles to the thigh. An
assistant meantime steadies the pelvis by making firm pressure over
the iliac crests.

As the chief obstacle to reduction is the tension of the ilio-femoral
ligament, the first indication is to relax this structure by flexing
the hip _to its fullest extent_.

In the _backward_ varieties (dorsal and sciatic) the [inverted
Y]-ligament is relaxed by flexing the thigh upon the pelvis in the
position of adduction. The thigh is then fully abducted, to cause the
head of the bone to retrace its steps forwards towards the rent in the
capsule; and at the same time rotated laterally to relax the rotator
muscles. This combined movement tends also to open up the rent in the
capsule. Finally, the limb is quickly extended to cause the head to
enter the socket. This object is often aided by making vertical
traction or lifting movements on the abducted and laterally rotated
limb before extending.

For the reduction of the _forward_ varieties (obturator and pubic),
the thigh is first fully flexed on the pelvis, but in the abducted
position. The limb is then strongly rotated medially and abducted, and
finally extended. Lifting movements may be found useful in these cases
also.

All methods of reduction by forcible traction on the e