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/lit25760/824/
ABNORMAL CONDITIONS OF THE HIP-JOINT. 
816 
elongated. The psoas magnus and iliacus in¬ 
ternus are relaxed, as are also the other muscles 
inserted into the trochanter minor.”* 
From the foregoing opinions Mr. Todd dis¬ 
sents in the following words :—“ To admit of 
the head of the femur being 4 forced towards 
the superior and external part of the aceta- 
balum/ and of its ascending 4 on the external 
face of the os ilium/ it will be obvious to 
those who carefully examine the mechanism of 
the articulation, that the thigh must be ex¬ 
tended on the trunk, and the dislocating force 
applied externally and inferiorly, so as to pro¬ 
duce what may be termed an excess of ad¬ 
duction. To the limb assuming such positions, 
which appear to me to be quite essential to¬ 
wards the production of this dislocation in the 
manner described by Bayer, some considerable 
obstacles exist. In the first place, I believe it 
seldom happens that a person who falls from a 
height will reach the ground with the thigh 
extended on the trunk ; in the descent the 
superior power of the flexor muscles will pre¬ 
dominate, and at the moment of the appli¬ 
cation of force to the limb it will be more or 
less in a bent position. It is scarcely neces¬ 
sary to observe that this circumstance must 
materially influence the direction in which the 
head of the bone will be protruded from the 
articulating cavity. 
44 Secondly, should the thigh and leg be com¬ 
pletely extended at the time that the force is 
applied, it is probable that the other limb will 
be extended also, and will thus prevent a move¬ 
ment of the stricken limb inwards beyond a 
certain point ; or, in other words, the opposite 
limb will prevent that extent of adduction 
inferiorly which is necessary to remove the 
head of the femur from the acetabulum, and to 
admit of its being forced upon the anterior 
convex surface of the dorsum ihi. But whether 
the opposite limb be extended or not, it must 
oppose a certain limit to adduction, if that 
term can be applied with propriety to a 
lateral movement of the lower extremity, by 
which it is carried beyond the middle line of 
the body. 
44 Sir Astley Cooper attributes this direction 
of the limb to the circumstance of the injury 
being inflicted when the knee and foot are 
actually turned inwards; however, it appears 
to me that muscular action is also in favour of 
the limb assuming this position. 
44 If it be admitted that the thigh is generally 
in a state of demiflexion when the force causing 
this dislocation is applied, it must also be ad¬ 
mitted that in this state the pyriformis, ob- 
turatores, and gemini have but little effect as 
rotators, the power of these muscles as such 
being greater or less, according as the junction 
of their fibres with the femur approaches 
or deviates from a right angle ; and that the 
power of the anterior portion of the glutæus 
médius and of the tensor fasciae latæ, as 
rotators inwards, is increased in this position, 
the angle which their fibres form with the 
thigh-bone being augmented ; thus the last- 
* Lectures of Boyer, p. 156. 
mentioned muscles will appear to possess 
much influence in determining the inverted po¬ 
sition of the limb, as they must draw forwards 
the trochanter major and external side of the 
thigh, at the moment in which the head of the 
bone escapes from the acetabulum. 
44 The inclination of the thigh forwards and uj 
inwards which constitutes so remarkable a fea- K 
ture of this dislocation, may be attributed f. 
partly to the tension of the psoas magnus, the a 
iliacus internus, and the pectinalis, and also 1 
to the peculiar form of the surface of the i 
pelvis, to which the upper part of the femur )1 
is applied ; but certainly not as Mr. Samuel 13 
Cooper has asserted, to the tense state of the ] 
triceps and gracilis, for these muscles are re- V 
laxed.” 
Anatomical characters of the luxation of the ’ 
head of the thigh-bone on "the dorsum ilii.—The 
appearances which have been noticed in the 
anatomical examination of the hip-joints of 
individuals who, having had a luxation of this 
articulation, have died very soon afterwards 
of other severe injuries received at the same 
time, may be collected from the study of some 
facts of this nature already published. Of 1 
these none gives us a better idea of the recent 
effects of a dislocation upwards and backwards 
on the dorsum ilii than the case related by the 
late Mr. Todd, in the third volume of the Dub¬ 
lin Hospital Reports, which is as follows :— , 
Case.—In the summer of 1818, a robust 
man, in attempting to escape from his bed¬ 
room window in the second floor of a lofty 
house, fell into a flagged area, by which acci¬ 
dent his cranium was fractured, and his left 
thigh dislocated upwards and backwards. 
The dislocation was reduced without diffi- 1 
culty ; however, an extensive extravasation of 
blood having taken place on the brain, the 
patient lingered in a comatose state for about 
twenty-four hours, and then died. On the 
day after dissection was performed, and the , 
following appearances were observed in the in¬ 
jured joint and the parts contiguous to it. 
On raising the glutæus maximus, a large 
cavity filled with coagulated blood was found 
between that muscle and the posterior part of 
the glutæus médius. This was the situation 
which had been occupied by the dislocated 
extremity of the femur. The glutæus médius 
and minimus were uninjured. The pyriformis, 
gemini, obturatores, and quadratus were com¬ 
pletely torn across. Some fibres of the pec¬ 
tinalis were also torn. The iliacus, psoas, and 
adductors were uninjured. The orbicular liga¬ 
ment was entire at the superior and anterior 
part only, and it was irregularly lacerated 
throughout the remainder of its extent. The 
inter-articular ligament was torn out of the de¬ 
pression on the head of the femur, its attach¬ 
ment to the acetabulum remaining perfect. 
The bones had not sustained any injury. 
Cruveilhier, in the 28th and 29th livraisons 
of his valuable work on Pathological Anatomy, 
has given two cases of what he considers to be 
old luxations of the head of the femur up¬ 
wards and outwards on the dorsum ilii, which 
had been left unreduced ; the history of these ;
        

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