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1833GerdyPN

 

P.N. Gerdy, in his experiment, discovered tensioning of the ligamentum capitis femoris (LCF) during thigh adduction. At the same time, it was noted for the first time that the consequence of LCF tension during hip adduction is a downward and lateral displacement of the femoral head. Normally, this mechanism provides unloading of the upper articular surfaces when supporting one leg (see 1874SavoryWS).

The translation from French was done in collaboration with ChatGPT 3.5. 


Gerdy PN. Physiologie médicale, didactique et critique. T. 1. Paris: Librairie de Crochard, 1833. [fragment]

Quote pp. 551-554

 

L'inclinaison de la cuisse en dehors, que l'on nomme son abduction, est un mouvement assez étendu, mais qui pourtant ne permet pas à la cuisse de se placer perpendiculairement à sa direction verticale. Les batteleurs peuvent se reposer sur un plan horizontal, les cuisses écartées en sens opposé.

Dans l'inclinaison de la cuisse en dehors, la tête du fémur glisse de haut en bas dans la cavité cotyloïde, et se meut autour d'une ligne qui la traverse d'avant en arrière. Cependant, la capsule ligamenteuse se relâche par en haut, se tend par en bas, menace de se rompre, et la tête du fémur de se luxer dans ce sens mais le ligament inter-articulaire, qui s'est relâché dans ce mouvement parce que son attache supérieure s'est rapprochée de l'attache inférieure, se pelotonne dans la grande échancrure de la cavité cotyloïde, et il concourt à arrêter le mouvement du fémur, par le seul relief qu'il fait sur la tête de cet os. Ce relief concourt à borner ce mouvement, en s'accrochant pour ainsi dire contre le bourrelet qui convertit en trou la grande échancrure du bord de la cavité cotyloide. Et qu'on ne croie pas qu'il y ait rien de supposé dans cette explication! Je me suis assuré de l'exactitude de ce fait sur le cadavre, en emportant la partie antérieure de l'articulation pour étudier ensuite ce qui se passe dans son intérieur pendant ses mouvemens.

Les agens de l'abduction de la cuisse sont le tenseur de l'aponévrose fémorale, les muscles fessiers et pyramidal de la cuisse.

Les muscles qui résistent à ce mouvement sont le grèle interne, le pectiné et les adducteurs. Mais la jambe et le pied prolongent plus loin la résistance par leur poids.

Or, comme le fémur s'appuie toujours dans la cavité cotyloïde, il forme encore un levier du troisième genre. Dans cet effort, on voit toujours se dessiner le plan du tenseur de l'aponévrose fémorale, en dehors de la hanche, et l'aponévrose fémorale faire sentir en dehors du genou une sorte de corde tendineuse qui aboutit à un tubercule antérieur et externe du tibia. Il n'y a cependant point de tendon en cet endroit. Cette apparence tient à une disposition variable que j'ai décrite dans mon Anatomie des formes, à l'occasion de celle du genou.

Dans l'inclinaison de la cuisse en dedans, mouvement que l'on nomme son adduction, le fémur se porte en dedans et croise la cuisse opposée. Et si nous supposons qu'il la croise en passant par devant, alors la tête de cet os glisse de bas en haut dans la cavité cotyloïde, en tournant autour d'une ligne qui la traverserait d'avant en arrière et un peu en bas. Par ce mouvement, la tête du fémur entraîne en haut l'extrémité supérieure du ligament inter-articulaire qui, retenu par en bas, au bord même de sa cavité cotyloïde, se tend bientôt, par suite se redresse, et, si le mouvement continue, repousse le fémur hors de sa cavité articulaire, à-peu-près par le même mécanisme qu'il en serait repoussé si l'on tendait avec une force suffisante une corde qui, fixée au bord de la cavité cotyloïde, la traverserait d'un côté à l'autre par le milieu de sa largeur. Vous pouvez vérifier ce fait en emportant avec la scie la partie antérieure de l'articulation coxo-fémorale. En poussant alors le fémur dans l'adduction, vous verrez le ligament inter-articulaire détacher malgré vous, de haut en bas, la tête de l'os de la surface de sa cavité, et détruire une première résistance à la luxation du femur en haut et en dehors, je veux dire l'adhérence des deux surfaces humides qui ne peut être détruitc que par un assez grand effort. Le fémur chassé de sa cavité, le ligament inter-articulaire et la partie supérieure de la capsule ligamenteuse coxo-fémorale sont obligés de soutenir le poids du corps, sans le secours tout puissant du bord supérieur de la fosse cotyloïde, et si alors l'action du poids du corps se trouve augmentée par la vitesse d'une chute, ces ligamens peuvent se rompre, et la luxation en haut et en dehors en être la suite immédiate.

C'est en effet par ce mécanisme que survient cet accident. Si, à ces premières observations sur le mécanisme des luxations en haut et en dehors, vous ajoutez que les mouvemens d'adduction sont peu étendus comparativement à ceux d'abduction, vous comprendrez facilement qu'il doit se rencontrer plus de causes pour pousser la cuisse dans une adduction excessive, et dès lors vous comprendrez pourquoi les luxations du fémur en haut et en dehors sont moins rares que celles qui se font en bas et en dedans.

Cependant la saillie, plus considérable du bord supérieur de la cavité cotyloïde, la plus grande épaisseur de la capsule ligamenteuse en haut qu'en bas, la résistance du ligament inter-articulaire, le peu d'étendue de l'adduction de la cuisse, des dispositions tout opposées pour la partie antérieure et inférieure de l'articulation et des mouvemens d'abduction beaucoup plus étendus que ceux d'adduction, rendent encore inexplicable aux praticiens les plus distingués la rareté comparative des luxations en bas et en dedans; mais il me paraît évident, d'après ce que j'ai dit du mécanisme des mouvemens du fémur: 1°. Que la saiilie du bord supérieur de la cavité cotyloïde ne peut s'opposer à la luxation en haut et en arrière, puisque la moindre adduction de la cuisse fait sortir la tête du fémur hors de sa cavité articulaire; 2°. Que la résistance du ligament inter-articulaire et de la partie supérieure de la capsule ligamenteuse, ne saurait soutenir seule le poids du corps, augmenté par toute la vitesse d'une chute. Quant au peu d'étendue de l'ad- duction, cette circonstance favorise la luxation en haut et en dehors ainsi que je l'ai démontré. Je me crois donc fondé à trouver l'explication de la fréquence des luxations en haut et en dehors, dans le mécanisme des mouvemens du fémur, que je viens d'exposer, et dans la fréquence des causes qui peuvent porter le fémur dans une adduction foreée.

The outward tilt of the hip, known as abduction, is a relatively broad movement, yet it still does not allow the thigh to align perpendicular to its vertical direction. Jugglers can lean on a horizontal plane, spreading their thighs in opposite directions.

During outward tilting of the hip, the head of the femur slides up and down in the acetabulum and moves around a line that crosses it from front to back. However, the ligamentous capsule relaxes from above, stretches from below, threatening to tear and dislocate the head of the femur in this direction, while the intra-articular ligament, which relaxes during this movement because its upper attachment has moved closer to the lower attachment, nestles into the large notch of the acetabulum and contributes to stopping the movement of the femur, solely through the relief it creates on the head of this bone. This relief helps to limit this movement, so to speak, by pressing against the ridge [acetabular labrum?] that turns the large notch on the edge of the acetabulum into a hole. And let no one think that anything is assumed here! I confirmed the accuracy of this fact on a cadaver by removing the front part of the joint to study what happens inside it during its movements.

The agents of thigh abduction are the tensor fasciae latae muscle, the gluteal muscles, and the piriformis muscle of the thigh.

The muscles that oppose this movement are the gracilis, pectineus, and adductors. However, the leg and foot continue to resist further due to their weight.

Since the thigh always rests in the acetabulum, it forms a third-class lever. In this effort, one can always observe the involvement of the tensor fasciae latae outside the thigh, and the fascia lata is palpable outside the knee as a sort of tendinous cord that terminates at the anterior and lateral tubercle of the tibia. However, there is no tendon here. This appearance is due to a variable structure that I mentioned in my "Anatomy of Forms" regarding the structure of the knee.

During medial tilting of the thigh (a movement called adduction), the femur shifts medially and crosses the opposite thigh. And if we assume that it crosses it by passing in front, then the head of this bone slides up and down in the acetabulum, rotating around a line that would cross it from front to back and slightly downward. By this movement, the head of the femur pulls up the upper end of the intra-articular ligament, which, held from below at the very edge of its acetabular cavity, soon stretches, then straightens, and with further movement pushes the femur out of the joint cavity almost by the same mechanism as if it were pushed backward with sufficient force a rope, which, anchored at the edge of the acetabulum, would pass through it from one side to the other through its middle. You can verify this by removing the front part of the hip joint with a saw. Then, by directing the femur into adduction, you will see how the intra-articular ligament involuntarily separates the head of the bone from the surface of its cavity from top to bottom and destroys the initial resistance to dislocation of the femur, displacing it upwards and sideways, I mean the adhesion of two wet surfaces, which can only be destroyed by applying quite a large force. The femur, brought out of the acetabulum, the interarticular ligaments and the upper part of the hip joint capsule are forced to support the weight of the body without the almighty support of the upper edge of the acetabulum, and if at this moment the action of the weight is increased by the speed of the fall, these ligaments can tear, and dislocation upward and to the side will be the immediate result.

Indeed, this is precisely the mechanism by which this incident occurs. If to these primary observations about the mechanism of upward and outward dislocations we add that the movements of adduction are smaller compared to abduction, then it is easy to understand that there must be more reasons for forcing the hip into excessive adduction, and therefore understand why hip dislocations up and out are less rare than those that occur down and in.

However, the more prominent protrusion of the upper edge of the acetabulum, the greater thickness of the ligamentous capsule at the top compared to the bottom, the resistance of the intra-articular ligament, the limited movement of thigh adduction, opposite locations for the anterior and inferior parts of the joint, and the wider movements of abduction compared to adduction further complicate the understanding for even the most experienced practitioners regarding the relative rarity of dislocations downwards and inwards. However, in my view, based on the mechanism of thigh movements that I have just outlined: 1°. The protrusion of the upper edge of the acetabulum cannot resist dislocation upwards and backwards, since even slight adduction of the thigh removes the femoral head from its joint cavity; 2°. The resistance of the intra-articular ligament and the upper part of the ligamentous capsule cannot independently withstand the weight of the body increased by the speed of falling. As for the limited movement of adduction, this characteristic contributes to dislocation upwards and outwards, as I have shown.  I therefore believe that the explanation for the frequency of upward and outward dislocations is to be found in the mechanism of movement of the hip which I have just outlined, and also in the frequency of causes which may force the hip into forced adduction.




External links

Gerdy PN. Physiologie médicale, didactique et critique. T. 1. Paris: Librairie de Crochard, 1833. [books.google]

Authors & Affiliations

Pierre Nicolas Gerdy (1797-1856) was a French surgeon, anatomist, pathologist and physiologist, professor with the Faculty of Medicine in Paris. wikipedia.org

Portrait of Pierre Nicolas Gerdy (unknown date)
The author of the image is Maurir; engaved by Rosselin;
Original in the wikimedia.org collection (CC0 – Public Domain, no changes)

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, ligament inter-articulaire, anatomy, physiology, role, significance 

                                                                     .

NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7

ROLE AND SIGNIFICANCE

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