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.
