Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25760/788/
780 
ABNORMAL CONDITIONS OF THE HIP-JOINT. 
Circumduction combining the four preceding 
is a compound movement, in which the inferior 
extremity describes a cone, the apex of which 
is at the joint ; the head of the femur in the 
course of this motion successively assumes the 
several situations already described. 
In rotation outwards the head of the femur 
is directed forwards and inwards, the anterior 
surface of the neck looks outwards, the pos¬ 
terior inwards resting on the brim of the ace¬ 
tabulum ; the capsular ligament is put upon 
the stretch on its inner side. Any sudden jerk 
or violence when in this position is liable to 
produce dislocation upwards upon the pubis. 
In rotation inwards the bone assumes the 
contrary direction, and the capsular ligament 
and ligamentum teres are equally put upon the 
stretch. In this case dislocation may occur 
either upon the dorsum of the ilium or into the 
sciatic notch. For this motion we have but few 
muscles, this position being produced merely 
by the tensor vaginse femoris and anterior fibres 
of the gluteus médius muscles. The disparity 
between the number of muscles influencing the 
motions of rotation outwards and inwards is 
very striking, but this may be attributed to the 
direction of the acetabulum from within out¬ 
wards and forwards naturally tending to pro¬ 
duce rotation inwards. Consequently before 
the opposite motion can be effected there is 
this inequality to be overcome, and hence the 
disparity between the muscles. 
(H. Hancock.) 
HIP-JOINT, ABNORMAL CONDI¬ 
TIONS OF THE—In this article we shall 
adopt an arrangement similar to that which we 
have followed in our former observations on the 
abnormal conditions of particular joints, and 
consider these states under the heads of, 1. 
congenital malformations; 2. the effects of 
disease, and, 3. the results of accident. 
Section I. Congenital malformation of the 
hip-joint.—The peculiar affection termed by the 
continental surgeons congenital or “original lux¬ 
ation ” of the hip-joint, has not in our islands at¬ 
tracted the notice that it seems to us to merit. 
When we reflect upon the very valuable addi¬ 
tions which have been made to our knowledge of 
the pathology of the articulations by British 
writers, and observe their silence upon this ab¬ 
normal state of the hip-joint, we might be led 
to infer that this malformation had no existence 
in these islands; this, however, unfortunately is 
not true. 
In the very valuable museums in London we 
can easily recognise many unquestionable spe¬ 
cimens of this congenital malformation of the 
bones of the hip-joint. In Dublin we know 
some living examples of it, and our museums 
contain preparations shewing some of its va¬ 
rieties and most of its usual anatomical charac¬ 
ters. ... 
At the meeting of the British Association in 
Dublin in the year 1835, Dr. Hutton made 
some interesting observations on this affection 
to the section of medical science, and gave an 
account of a well-marked example of it affect¬ 
ing one hip-joint. On that occasion Dr. 
Handyside observed that he had met with a 
case of congenital luxation of both hip-joints, 
in a subject which had been brought into his 
anatomical rooms at Edinburgh ; and he added 
that the appearances of the joints corresponded 
very closely with those noticed by Dr. Hutton. 
The Professor of Anatomy and Surgery to the 
University of Dublin, Dr. Harrison, laid before 
the Surgical Society last winter the results of 
two accurate post-mortem examinations which 
he had made of this malformation of the hip- 
joint. The history of these cases, as far as Dr. 
Harrison could make it out, shewed that the 
subjects of them had during life presented the 
ordinary signs of the infirmity in question. 
In one of them, one hip-joint only was af¬ 
fected ; in the second, not only was the arrest 
of development such as to leave the acetabu¬ 
lum a plane surface by depriving it of border 
of any kind, but the ligamentum teres, the 
head and greater part of the cervix femoris 
were also deficient on both sides, so that the 
femora at their upper extremity presented a 
rude resemblance to the ossa humeri. In this 
case (fig. 307) the capsular ligament was of an 
extraordinary length, and permitted the rudi¬ 
ment of a head and neck, with the trochanter 
major, to ascend and descend on each side on 
the dorsum ilii, and to pass backwards on the 
ischium to the very edge of the ischiatic notch, 
in the different movements of the patient. 
The case of congenital malformation of the 
hip-joint has not escaped the notice of conti¬ 
nental surgeons,* although perhaps the nature of 
the affection had not fully attracted the attention 
of the profession until Dupuytren f gave the 
results of his observations of twenty-six cases of 
this malformation which were presented to him 
in the course of his public and private practice. 
He seems to have met with the affection more 
frequently in the female than in the male, in 
the vast proportion of twenty-two females to 
four males, and from his description it would 
appear that he has usually found, in the same 
individual, both hip-joints affected. In the 
cases we have witnessed, we have not observed 
this very great preponderance of female over 
male cases ; and although we have noticed the 
defect to be double in the same individual, we 
have more frequently observed but one joint 
engaged. This is of importance to be recol¬ 
lected, as mistakes in our diagnosis are more 
likely to occur when only one joint is affected, 
than in those cases in which the defect is 
double in the same individual. 
The characters, says Dupuytren, of this 
“ original luxation” are nearly similar to all 
those we notice belonging to the ordinary luxa¬ 
tion upwards and backwards on the dorsum 
of the ilium : the limbs are shortened and inver¬ 
ted ; the superior extremities of the femora are 
carried upwards, backwards, and outwards, into 
the external iliac fossa, where a considerable 
prominence can be seen, caused by the unusual 
elevation of the great trochanter; the thighs, 
unusually slender, are obliquely directed down- 
* Palletta, Lafond, Callard, Bellomeir. 
f Repertoire d’Anatomie, Leçons Orales.
        

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