Bauhaus-Universität Weimar

The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Todd, Robert Bentley
uppe- and back part of the acetabulum. The 
crepitus and frequent recurrence of the dis¬ 
placement rendered it sufficiently obvious that 
the brim of the acetabulum had been broken 
in the above-mentioned situation. The bone 
was a third time restored to its place, and a 
strong band placed around the pelvis. In 1836, 
I admitted the man into the Richmond Hos¬ 
pital. He was at this time unable to walk 
without the assistance of a crutch. The in¬ 
jured limb was one inch and a half shorter than 
the other. When standing, he rested it upon 
the points of the toes, the heel being drawn 
upwards ; but a slight degree of extension was 
sufficient to restore it to its natural length ; and 
when the man was lying in bed there was 
hardly any difference perceptible in the length 
of the two limbs. The breadth of the injured 
hip was occasionally greater than that of the 
sound one, and the head of the femur could be 
pushed upwards easily, and, of course, it al¬ 
ways ascended, when the patient endeavoured 
to support his weight upon it ; and in many 
motions of the joint, the rubbing together of the 
broken surfaces was distinctly audible. 
After having remained in the Richmond 
Hospital under our observation for two months, 
he was discharged. Nothing could be devised 
to make his limb more useful to him. The 
fracture, therefore, of the supercil ium of the ace¬ 
tabulum is a very serious injury, which it be¬ 
hoves surgeons to be well acquainted with. A 
successful mode of managing such cases has 
not yet been exemplified.* 
2. Fracture of the superior extremity of the 
femur.—The head of the femur is so protected 
by the acetabulum, that it is seldom or never 
fractured, except by gunshot injuries. The 
neck and rest of its superior extremity are, 
however, we .find, subjected to various accidents. 
The general symptoms of fractures of the neck 
and upper extremity of the femur are, that the 
affected limb is shorter than the other, the heel 
rises to the level of the opposite malleolus, the 
patella, leg, and foot seem much everted ; there 
js a flattening of the natis, and a fulness of the 
groin. The patient does not attempt to stand, 
much less to walk. There is in the part itself, 
as it were, a conscious inability to support the 
-weight of the body, and even when the patient 
is lying on a horizontal plane, as in bed, we 
find, that he cannot, by the unassisted effort of 
the muscles of the injured limb, elevate it from 
the horizontal level, upon which it lies power¬ 
less. When the surgeon, standing at the foot 
of the bed, seizes fhe affected limb, and pulls 
it towards him, so as gradually to overcome the 
contractile power of the muscles, the limb is 
restored to its natural length, and if now we 
resort to the painful expedient of rotating the 
thigh, crepitus is rendered manifest. When¬ 
ever the surgeon relaxes the force by which the 
limb was restored to its'natural length, the 
shortening, eversion, and deformity of the limb 
* In the twelfth volume of the Dublin Medical 
Journal, Mr. R. Smith has made some valuable 
observations on this case, in relation to the diag¬ 
nosis of obscure cases of injury of the hip and 
recur. Such are the general signs of fracture 
of the upper extremity of the thigh-bone. 
The portion of the bone, called the neck, may 
be fractured transversely with respect to the 
direction of its long axis, either within or with¬ 
out the capsular ligament. The first is deno¬ 
minated the intra-capsular fracture, the second 
the extra-capsular fracture. Oblique fractures 
of the neck of the bone are not impossible. 
A. Intra-capsular fracture of the neck of 
the femur. — This fracture has been seldom 
seen in the young subject, but is one of the 
most common accidents to which elderly peo- ;| 
pie are liable. In such persons many cir- ® 
cumstances in their organization appear to ac¬ 
count for their great liability to this accident. 
Their muscles have lost their firmness, and are 
more or less in a state of atrophy ; the trochan¬ 
ter major becomes peculiarly prominent; the ; 
neck of the femur yielding somewhat, perhaps, 
to the weight of the body, descends and loses 
some of its obliquity. This atrophy of the 
muscles and bones is not so frequently noticed 
in the male as in the elderly female, in whom 
the breadth of the pelvis is greater and the tro- I 
chanter major more projecting. These obser¬ 
vations account sufficiently for the great liability 
to the intra-capsular fracture, which we notice 
in the elderly subject, and for the more fre¬ 
quent occurrence of the accident in the aged 
female than in the male. In the young subject 
the trochanter major does not project so much, 
the muscles surrounding the hip-joint are re¬ 
markably firm, and when falls on the side 
occur, the surrounding muscles and the os in- 
nominatum share, with the great trochanter, the 
weight of the fall. The bone in the young J 
subject is better calculated from its form and 
its organization to resist the effects of falls on 
the trochanter, and in these fractures of the 
neck of the femur have been rarely witnessed. 
In the young subject, too, the neck of the 
femur is comparatively shorter than in the aged, 
the angle of union of the neck with the shaft of 
the bone is more open, and the axes of both 
neck and shaft are more in a line. The great 
proportion of animal matter existing in the 
bones of the young, and consequent elasticity 
of the bone, render it capable of resisting frac¬ 
ture, while, on the contrary, the comparative 
deficiency of animal matter, and the consequent 
redundancy of earthy material in the aged sub¬ 
ject, render the neck of the femur friable. In 
a w-ord, the tissue of the bones in general does 
not escape, in the aged, that atrophy which 
affects the rest of the system, and when we re¬ 
collect the functions which the neck of the 
thigh-bone has to perform, we shall not be sur¬ 
prised to learn that the effects of this atrophy 
are more readily felt and seen in this part of 
the osseous system than perhaps any other. 
The superincumbent weight of the body and 
the action of muscles must have a tendency to 
diminish the obliquity of the neck of the thigh¬ 
bone, to render it more horizontal, and conse¬ 
quently less capable of bearing up against the 
effects of concussion. 
Besides the loss of obliquity of the neck of 
die thigh-bone, we find two other circumstan-


Sehr geehrte Benutzer,

aufgrund der aktuellen Entwicklungen in der Webtechnologie, die im Goobi viewer verwendet wird, unterstützt die Software den von Ihnen verwendeten Browser nicht mehr.

Bitte benutzen Sie einen der folgenden Browser, um diese Seite korrekt darstellen zu können.

Vielen Dank für Ihr Verständnis.