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/lit25760/828/
820 
ABNORMAL CONDITIONS OF THE HIP-JOINT. 
published by Mr. Bransby Cooper* as one 
of dislocation on the dorsum ilii, was ra¬ 
ther the dislocation we are now considering, 
namely, the luxation towards the ischiatic 
notch. Among some of this patient’s symp¬ 
toms, it is mentioned that the trochanter major 
was plainly felt behind and a little above the 
natural situation with respect to the ilium ; the 
head of the bone could be felt neither in the 
sitting, standing, nor lying posture. Indeed, 
Mr. B. Cooper himself remarks that, “ upon 
taking into consideration all these diagnostic 
marks, I was induced to consider the acci¬ 
dent a luxation on the dorsum of the ilium ; 
although the head of the bone was not drawn 
up so high as usual, as indicated by the slight 
shortening of the limb ; and the trochanter 
major was also drawn further backwards than 
is usual, in the dislocation on the dorsum, so 
that, perhaps, this might by some surgeons have 
been described as a dislocation to the ischiatic 
notch.” Mr. Cooper further adds :—“ I doubt, 
however, if this appellation as applied to a cer¬ 
tain variety of dislocation of the hip, does not 
rather mystify than facilitate our diagnosis, 
for it leads to the supposition that the head of 
the bone sinks into the osseous hiatus,—a cir¬ 
cumstance which could not occur even in the 
skeleton itself, from the size of the head of the 
bone, and much less could it happen in the 
living subject, when this notch is filled up 
with ligaments, muscles, vessels, and nerves.” 
This respectable surgeon proposes, therefore, 
to expunge from the classification of dislocations 
the luxation into the notch, but to consider it 
only as a variety of the dislocation on the 
dorsum ilii, distinguishing the one as a luxation 
upwards, the other backwards, on the dorsum. 
To this proposition we cannot by any means 
assent, for we consider that a dislocation back¬ 
wards behind the ischium, and to the ischiatic 
notch which is below the level of the ilium, 
never can be properly designated a variety of 
the dislocation on the dorsum ilii, although we 
might assent to the proposition to consider it a 
variety of the dislocation backwards. The 
case as described by Sir A. Cooper, of disloca¬ 
tion on the sciatic notch, we are satisfied is to 
be seen occasionally, though rarely, in the living; 
and the dissection made by Sir Astley himself, 
in which he found the head of the bone resting 
behind the acetabulum on the pyriform muscle, 
the preparation of which is to be found in the 
museum of St. Thomas’s Hospital, should, 
we imagine, place the matter beyond dispute. 
Anatomical characters.—We have, says Sir 
Astley Cooper, a good specimen in the collec¬ 
tion of St. Thomas’s Hospital, which I met 
accidentally in a subject brought for dissection. 
The original acetabulum is entirely filled with a 
ligamentous substance, so that the head of the 
bone could not have been returned into it. The 
capsular ligament is torn from its connection 
with the acetabulum at its anterior and posterior 
junction, but not at its superior and inferior. 
The ligamentum teres is broken, and an inch of 
* Guy’s Hosp. Reports, Jan. 1836. 
it still adheres to the head of the bone. The 
head ot the bone rests behind the acetabulum, 
on the pyriformis muscle, at the edge of the 
notch above the sacro-sciatic ligaments. The 
muscle on which it rests is diminished, but 
there has been no attempt made to form a new 1 
bony socket for the head of the os femoris 4 
Fig. 324. 
Around the head of the thigh-bone a new 
capsular ligament is formed ; it does not adhere 
to the articular cartilage of the ball of the 
bone which it surrounds, but could, when 
opened, be turned back to the neck of the * 
thigh-bone, so as to leave its head completely 
exposed. 
Fig. 324. 
Luxation in the sciatic notch.* 
Within the new capsular ligament, which is 
formed of the surrounding cellular membrane, 
the broken ligamentum teres is found. The 
trochanter major is rather behind the acetabu¬ 
lum, but inclined towards it relatively to the 
head of the bone. This dislocation, he adds, 
must have existed, from the appearances of the 
parts, many years. The adhesions were too 
strong to have admitted of any reduction, and 
if reduced, the bone could not have remained 
in its original socket. 
c. Luxation upwards and inwards on the 
pubes.—This luxation is more easy of detection 
than any other of the thigh. It happens from a 
person while walking putting his foot into 
some unexpected hollow in the ground, and 
his body at the moment being bent backwards, 
the head of the bone is thrown forward upon 
the os pubis. 
The limb in this species of dislocation is 
an inch shorter than the unaffected one; the 
knee and the foot are turned outward, and 
* From Sir A. Cooper, pi. iv. on Fractures and 
Dislocations.
        

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