ON DISLOCATIONS, ESPECIALLY OF THE HIP-JOINT, ACCOMPANIED BY ELONGATION OF THE CAPSULE AND LIGAMENTS.
By EDWARD STANLEY, F.R.S.,
SURGEON TO ST. BARTHOLOMEW'S HOSPITAL.
READ JANUARY 12TH, 1841.
It may be presumed that observations similar to those which I am about to submit to the Society, have occurred to other pathologists and surgeons; yet as the subject of dislocations of the larger joints, and especially of the hip, occurring under other circumstances than as the direct consequence of external violence, or of the destructive processes of inflammation, has not, as it has appeared to me, received the attention which its importance demands, I have thought that the following cases, with the reflections they suggest, might not be unacceptable.
Case I. Dislocation of both hip-joints, consequent on disease of the
spinal cord, and probably of the brain.
A gentleman, aged thirty-nine, in the year 1824, was attacked with
spasms in the pectoral and intercostal muscles, and numbness in the whole of
the left side of the body, with the exception of the arm. In the left thigh and
leg, sensation was wholly lost, the power of motion remaining. He had no
sensation of passing his urine after it had quitted the bladder, and was but
just aware of the evacuation of the faeces. Vision in the left eye was impaired
to the extent that he could but distiniguish daylight. Disease of the brain was
supposed to be the cause of these symptoms, and a seton in the neck was
persisted in for six months without benefit. Subsequently, the spinal cord was supposed
to be the seat of disease, and for several months the back was stimulated with
tartar emetic ointment. The symptoms continued, with increasing weakness in the
thighs and legs, to the complete loss of the power of support, and of sensation
in them. Unless he saw his legs, he could not tell in what direction they were;
but on looking at them so as to know their position, he could readily move them.
At the same time, with a sense of tightness in the lower part of the back, he
felt as if a complete separation had taken place of his body from his thighs.
With the impairment of the natural sensibility of the limbs, he occasionally
suffered in them the most severe pains, sometimes attended with a smarting
sensation, at others, with the sensation of a blow frequently repeated. Red-hot
irons were now held close to the spine daily, but with no marked benefit. Such
is the outline of the case from its commencement in 1824 to the end of the year
1827, when there was a diminution in the severity of the pains, with recovery
to a limited extent of the power of moving the limbs. In March 1828 he was
again attacked with violent spasms in his body and limbs, which compelled him
to remain in bed several days. On rising from his bed when the spasms had
subsided, he found, to his great surprise, his right lower limb so much
shortened, that when erect he was but just able to touch the ground with his
great toe, and at the same time he remarked a protuberance at the upper and
back part of the thigh. In the following December there was a repetition of
these occurrences, but in the other limb, an attack of spasms being followed by
shortening of it, with a protuberance at the back of the thigh, as on the
opposite side. He could still bear the weight of his body upon his limbs, but
was almost wholly unable to move them. At no period had there been tenderness,
or other sign of inflammation in the soft parts around the hip-joints. Through
the next two years he very gradually improved in respect to the diminution of
the spasms, and the recovery of the power of moving the limbs, which brings the
narrative to June 1831, when, for the first time, the case falling under my observation,
I noted, in conjunction with other surgeons, the following particulars
respecting it.
The spasms and the attacks of pain are chiefly confined to the chest and
to the lower limbs; he suffers a distressing sensation of tightness with acute
pain on both sides of the chest, in the direction of the ribs from their angles
to the sternum. Movements of the arms excite this pain. Firm pressure by the
hands against the walls of the chest greatly relieves it. There is paralysis of
the rectus superior muscle of the left eye, and its sensibility to the
impression of light is much weakened. In the erect posture there is a
remarkable projection at the back of the pelvis, which, upon examination, is ascertained
to be caused by the extremities of the thigh-bones occupying this situation. In
rotating each thigh, the head of the femur can be felt moving freely beneath
the glutaei muscles. The trochanter major of each femur is thrown directly
backwards. The distance between each trochanter and the head of the bone is
natural. The head of each femur thus situated upon the posterior part of the
pelvis is two inches and a half below the highest part of the crista of the
ilium, and four inches distant from the anterior superior spine of the same
bone. In the erect posture, there is a diminution in the stature to the extent
of between five and six inches, and evidently from the pelvis sinking between
the thighs. In the horizontal posture, the thighs can be readily pulled
downward so nearly to their natural situation, that the shortening of the
stature is then only to the extent of between one and two inches. As a
consequence of the ascent of the thigh-bones to the back of the pelvis, the
whole form and outline of the thighs are altered, and at the upper and front
part of each thigh is a protuberance, apparently formed by the rectus muscle, not
yet adapted to the altered position of the femur. On a re-examination of the
case in 1833, I found that a moveable plate of bone, semicircular, thick, and
about three inches in extent, had formed immediately above the head of each
femur, which, in the erect posture, pressed closely against it; these osseous
plates might be regarded as the commencement of the formation of new acetabula.
From the year 1833 to the present time, there has been no material change in the symptoms. He still suffers attacks of severe pain and spasm in the pectoral and other muscles upon the sides of the chest, and in the muscles of the lower limbs, and after the trial of every variety of treatment, it is doubtful whether even a mitigation of suffering has been obtained from any other remedy than opium in some of its forms, to which he resorted at an early stage of his affliction, and has continued taking it in large daily doses. The extremities of the thigh-bones still project upon the back part of the pelvis as they did at the period of their displacement in the year 1828, but they are not so freely moveable as they then were, apparently from the thickening and consolidation of the surrounding cellular tissue. There has been a gradual recovery of the power of directing the movements of the limbs, which is now sufficient to enable him to walk at a slow pace, with the aid of a stick. It might of course be expected that under the most favourable circumstances, a long time would be required for the adjustment of the muscles of the pelvis and thighs to the altered situation of the thigh bones.
Case II. Dislocation of the hip-joint consequent on an attack of
hemiplegia.
I did not witness the following case, but the history of it is drawn out
by the gentleman who had the charge of it, and upon whose accuracy I can rely.
Agentleman aged 48 had been for above eight years affected with hemiplegia, chiefly perceptible in the left lower limb. He had been a courier, and he attributed his complaint to the severity and vicissitudes of weather to which he had been constantly exposed. Two years before his death, it became evident, as he moved about on crutches, that the affected limb had become considerably lengthened; this was accompanied bywastingof the limb, with a remarkableflaccidity of the muscles; andon rotating the thigh, the head of the femur could be so plainly felt, that it was concluded it must be out of its socket. This circumstance gave an interest to the case, which led to a careful examination of the hip-joint after death, when the following peculiarities were noticed: The capsule and the ligamentum teres were entire, but elongated to the extent of allowing the head of the femur to pass beyond the limits of the acetabulum. The brain presented no other morbid appearance than a preternatural quantity of fluid in the ventricles. The spinal cord was found healthy in its cervical and dorsal portions, but in its lumbar portion it was so pulpy as to be almost of a mucilaginous consistence. The roots of the lumbar nerves were in the same softened condition as the corresponding portion of the cord. The thoracic and abdominal viscera were healthy.
Case III. Dislocation of the hip-joint consequent on rheumatism.
Mary Elsely, aged 32, was admitted into St. Bartholomew's Hospital in December 1837, on account of general febrile disorder, combined with pain in the left shoulder-joint, in the right hip-joint and down the front of the thigh. She was in the fifth month of pregnancy; her occupation was that of a hawker of brushes, which exposed her to the vicissitudes of the weather. She stated that she had been in good health until within a fortnight of her admission, when she was attacked first with pain in the right elbow and left shoulder-joints, and afterwards in the back of the right thigh. The pain varying in severity, was occasionally acute; on some days it was confined to the thigh, and on others was excruciating through the whole limb from the hip to the toes. Throughout, there had not been more constitutional disturbance than might be referred to the amount of pain she endured. Her disorder was considered to be rheumatism, and the treatment of it was conducted accordingly, with the occasional applications of leeches, belladonna and opium plasters to the shoulder, hip, and thigh, while the internal remedies had been calomel and opium, to the extent of producing salivation, Dover's powder, hemlock, iodide of potassium, &c., each of these remedies in its turn procuring alleviation of the pain, but it again and again recurred in the same part. It was, therefore, but slowly that the complaints subsided, and it was not until she had been in the hospital above ten weeks that she had sufficiently recovered to be able to move from her bed, to which she had been hitherto strictly confined. On the first occasion of doing so, the woman discovered, as she said, to her horror, a shortening and distortion of the right lower limb, of the mode or time of occurrence of which she could not give the least account, not having the slightest suspicion of it, nor had anyone else, until, on getting out of bed, the hip was discovered to be dislocated. I examined the limb, and found it much inverted, and shortened to the extent of a little more than an inch and a half, and the displaced head of the femur could be plainly felt through the glutaei muscles upon the dorsum of the ilium. On rotating the limb, the head of the bone moved freely and without pain. There was no thickening, or in any other respect an unnatural condition of the soft parts, either contiguous to the acetabulum, or in the tract through which the head of the bone must have passed to the situation it now occupied. The woman being in the eighth month of pregnancy, it was not deemed prudent to make any attempt to replace the head of the bone in its socket; she accordingly left the hospital.
Case IV. Dislocation of the hip-joint consequent on pain in the thigh,
treated as sciatica.
A woman aged 30 was admitted into St. Bartholomew's Hospital in March 1838. She had been servant in a gentleman's family at Hampstead, where her illness had commenced with a painful swelling of one of the joints of the right thumb, which, after a day or two, subsided, and was immediately succeeded by pain and stiffness in the right hip-joint, so far impeding its motions, that she was occasionally confined to her bed. She was seen at this period by several medical men, who considered the case to be sciatica, and treated it as such for between two and three months before her admission into the hospital. She now complained of pain in the right hip, but extending upwards to the loins, and down the thigh, with stiffness of the whole limb. The skin was tender on pressure through the course of the ischiatic nerve. Succussion of the whole limb by the application of force to the sole of the foot, and with the knee-joint extended, produced no pain in the hip-joint; and although the movements of the hip were impeded by the pain in the thigh, and the general stiffness of the limb, yet she could bear the weight of her body upon it without much inconvenience. In the view still taken of the disease, as being sciatica, no other treatment was adopted than the administration of opium, with the application of mustard poultices to the limb. This treatment having been continued for some time without benefit, she was removed to a surgical ward, when there was discovered to be a complete dislocation of the affected hip, of the occurrence of which the woman had not the slightest idea, and was not able, therefore, to give any information respecting the exact time of its taking place; the only point that could be clearly ascertained was, that the dislocation must have occurred within the period of her stay in the hospital, through the whole of which she had been confined to her bed. The head of the femur could be plainly felt upon the dorsum of the ilium, and was freely moveable without pain. The limb was decidedly inverted, and shortened to the extent of nearly an inch and a half. There was no other swelling of the hip than that resulting from the displaced head of the femur, and there had been no evidence of inflammation in the soft parts around the hip-joint. The whole system was in a state of nervous excitement, which very gradually subsided, and in the same degree the uneasiness in the limb diminished. In about six weeks after her admission, she had become free from complaint, except the lameness consequent on the dislocation. An attempt was, in this case, made to bring the head of the femur downwards to the level of the acetabulum, with an apparatus which, by the operation of a pulley and weight, maintained a gradual but continued extension of the limb. This was persevered in for many weeks, whether or not with benefit was doubtful. When the woman left the hospital there was still a decided inversion and shortening of the limb.
Case V. Dislocation of the hip-joint consequent on rheumatism.
I was consulted in June 1836, respecting the propriety of attempting to
reduce a dislocation of the hip-joint which had occurred under the following
circumstances. A youth aged fourteen suffered, at Gibraltar, an attack of
inflammation in both hip-joints, with severe constitutional derangement, which
was reported to be of the nature of rheumatic fever. He was confined to his bed
above twelve months. Then, on beginning to move about, it was discovered that
the right hip-joint had become dislocated, but he was wholly unaware when the
dislocation had occurred. At the time of my seeing this patient, four years had
elapsed since the commencement of his illness. His general health is now perfectly
good. There is not the slightest pain in the hip or elsewhere, but the limb is
everted and shortened, as ascertained by exact measurement, to the extent of
three inches and a half. The trochanter major is greatly more prominent than in
the opposite limb, and the head of the femur is readily distinguished through
the glutaei muscles, having its proper relation to the trochanter consistent
with the integrity of the neck of the bone, and with the everted position of
the limb. Flexion and extension of the thigh are perfectly free. Rotation of
the thigh inwards can be executed, but not outwards. The soft parts of the hip,
and in its neighbourhood, are sound.
It was from the characters of this dislocation differing so materially from the ordinary dislocation of the hip-joint consequent on disease, that the question arose whether an attempt should -be made to replace the head of the femur in its socket. I had no hesitation in deciding against such a measure, from the consideration of the free action and usefulness of the limb, notwithstanding its shortened and everted position, bearing in mind also the little probability of the head of the bone remaining in its socket, should we be able to place it there, of which there could not but be considerable doubt. Why the limb had assumed, in this instance, an everted rather than the inverted position which it might be expected to have with integrity of the neck of the femur, cannot, I presume, be satisfactorily explained.
Case VI. Dislocation of the hip-joint, which occurred in the sixth week
from a fall.
A female, aged 14, in passing through a passage, the stones of which were slippery, fell upon the outer side of the right thigh. There immediately ensued a powerless condition of the limb, which was soon followed by severe pain and swelling in the front and outer part of the thigh, with spasms of the muscles. The surgeons summoned to the case could detect no deviation from the proper length and position of the limb, and accordingly expressed their opinion that the injury was confined to the muscles. At the expiration of a month there was no recovery of the power of using the limb, and the patient was in consequence removed to the sea side. Gentle efforts to walk were here made with the help of a stick, and at the same time the limb was every day placed in a vapour bath. At this period the patient occasionally remarked that she thought her hip was growing out; on one occasion, whilst using the vapour bath, she observed to her attendants that the projection of the hip had suddenly increased, and on examining the limb immediately afterwards, there was found to be a well-marked dislocation of the head of the femur. How this dislocation had occurred no opinion could be given; but the surgeon who had been in daily attendance was certain no dislocation had existed before the present time, which was in the sixth week from the occurrence of the fall. At this period I first saw the case in conjunction with other surgeons, when the following suggestions were offered respecting the probable nature of the injury that in the fall, the ligamentum teres had been ruptured, effusion of fluid then taking place into the capsule; this had gradually yielded, and by its elongation had allowed the head of the bone to pass out of the acetabulum to the dorsum of the ilium, upon which it was now situated. We found the space between the anterior superior spine of the ilium and the top of the patella to be an inch and a half less than on the opposite side. There was no tendency to inversion or eversion of the limb, and it could be moved freely in any direction, when the head of the bone might be felt rolling beneath the fingers placed upon the hip. The neck of the femur could be distinguished, and of its integrity there could be no doubt, from the movement of the head of the bone simultaneously with the trochanter, and from the preservation of the natural distance between the two prominences. It was judged improper to make forcible extension of the limb, as there might be some mechanical obstacle, such as the effusion of serum or lymph, to the return of the head of the bone into its socket. Accordingly, no other treatment was recommended than quietude of the limb, with the application of a bandage which might check the further ascent of the bead of the femur upon the ilium. When about six months had elapsed from the occurrence of the accident, the patient, on rising from her bed, exclaimed that the projection of the hip had disappeared, and that her limbs were of the same length. A careful examination of the injured limb confirmed the statement of the return of the head of the bone to its socket, but it subsequently became again displaced; for at a later period, the head of the femur could be plainly felt on the dorsum of the ilium, and the limb was now shortened to the extent of three inches, but still neither inverted nor everted. The power of using the limb was however progressively increasing, and evidently by the active advance of the natural processes combining to restore the usefulness of the limb in any case of unreduced dislocation, especially when occurring in a young and healthy person.
Case VII. Injury to the hip-joint, attended with shortening of the limb,
from a fall upon the knee.
A youth aged 18, in walking, was thrown down by his foot striking
against a pole which lay unperceived in his way. His face and left knee were
the only parts bruised. But on being raised from the ground, he was unable to
bear weight upon the left leg, and felt pain in the upper part of the thigh. He
remained in bed until the pain in the thigh ceased, and then, on moving about,
the limb was, as he stated, very feeble. Three months having elapsed from the
accident without the recovery of much power of using the limb, he was brought
from the country to St. Bartholomew's Hospital. Upon a careful examination of
the injured limb, the following particulars were ascertained respecting it. By
comparison with the sound limb, there was found to be a diminution of the space
between the anterior superior spine of the ilium and the top of the patella to
the extent of two inches. There was no inversion or eversion of the foot. The
head of the femur could not be anywhere distinctly recognized. The trochanter
major was considerably more prominent than on the opposite side. All the
movements of the thigh could be freely executed, and without pain. By moderate
extension with the hands, the limb could be brought down to its natural
position, when the unnatural prominence of the trochanter disappeared; but on
remitting the extension, this prominence reappeared, and the limb became again
shortened. No thickening or other morbid change could be discovered in the soft
parts around the hip-joint.
The first remark suggested by the perusal of the foregoing histories,
may be one of surprise, that cases differing in so many particulars should be
combined in one series, apparently without regard to the scientific precision
demanded by the present state of pathological knowledge; yet it will be observed,
that they are all striking illustrations of the important practical fact to
which it is my object to direct the attention of the Society, namely, the occurrence,
and by no means rare, of dislocations of the hip-joint, not as the direct
consequence of external violence, nor preceded or accompanied by such changes
in the soft parts around the articulation as are attendant on dislocations
resulting from the destructive processes of inflammation.
In the first and second cases which have been related, the displacement
of the head of the femur from the acetabulum occurred as a consequence of impaired
nervous power, combined with spasms in the muscles of the limbs, in one case
ascertained to be from disease of the spinal cord; and in the other, presumed,
from the collateral symptoms, to be from the same cause. It may be affirmed
that in the first, and very remarkable case, where both hip-joints were dislocated,
there had been, at no period, inflammation in the joints or contiguous parts;
and under such circumstances we must, I think, conclude that the pathological
changes in these joints had been the elongation of their capsules and ligaments.
In the second case, dissection showed such to be the condition of the joint,
the capsule and ligamentum teres being lengthened to the extent of allowing the
head of the femur to pass considerably beyond the acetabulum. We know that
lengthening of the arm may be the consequence of paralysis of the deltoid and
other muscles combining in their natural actions, to maintain the articular
surfaces in contact. It may be said that the looseness and thinness of the
capsule of the shoulder-joint permit no comparison of it with the dense, thick,
and closely-embracing capsule of the hip-joint. However this may be, we have
before us the fact of the lengthening of this capsule, and with it of the ligamentum
teres, of which no other account can be rendered than that it was a consequence
of impaired nervous power in the muscles surrounding the articulation.
In the third, and in the fifth case, the dislocation of the hip must be
viewed as the consequence of rheumatic inflammation in the fibrous and synovial
tissues of the joint; and in the fourth case, the dislocation may be ascribed
to the same cause, although the disease had been treated under the name of sciatica.
It can scarcely be a question, that in each of these three cases, the
pathological changes were elongation of the capsule, with either the elongation
or actual destruction of the ligamentum teres. The sixth and seventh cases are
examples of injuries to the hip-joint from external violence in young persons, followed
by a gradual shortening of the limb, which, from the attendant circumstances,
can be explained only by the yielding and consequent lengthening of the
ligamentous tissues of the joint. In the sixth case, the head of the femur was
gradually, and at a distant period from the injury, displaced from the
acetabulum. In the seventh case, a similar change in the relations of the
articular surfaces was indicated by the shortening of the limb, although the
head of the femur could nowhere be distinctly recognized. Other cases have been
reported to me of dislocations of the hip-joint, occurring gradually, and
without inflammation, after injuries from external violence. Whatever
difficulty there may be in explaining such a form of dislocation, the knowledge
of the simple fact of the possibility of its occurrence is of much importance
to the establishment of a correct diagnosis of the various injuries occurring
to the hip-joint.
It is well ascertained that inflammation of a mild character, whether rheumatic or otherwise, may, without evident change. in the organization of ligamentous tissue, so far affect its property of resistance, that it will yield considerably to an extending force; thus, in the knee-joint, the crucial and lateral ligaments may become lengthened to the extent of permitting such a displacement of the articular surfaces, that, from the view of the outside of the joint, it might be inferred actual destruction of the ligaments had taken place ; and it is to be observed, that these changes in the ligaments of a joint, very slow in progress, may be unaccompanied by pain, or other symptoms of inflammation. My colleague Mr. Wormald lately directed my attention to the following case of yielding of the ligaments of the knee-joint in one of the out-patients at St. Bartholomew's Hospital. A man, about 40 years of age, states, that about three years ago he caught a severe cold, immediately after which his knee became weak and swollen, and that there succeeded a very gradual alteration in the form of the joint, but unaccompanied by pain or other sign of inflammation. The articular surfaces are now displaced to the extent that the head of the tibia projects a full inch on the inner side of, and a little behind the inner condyle of the femur, with a corresponding hollow on the outer side of the joint, and some fluid within the joint can be felt on each side of the patella. In the hip-joint, from inflammation of a mild character, and probably commencing in its fibrous tissues, there may be effusion of fluid into the capsule with the yielding of it, and of the ligamentum teres producing, first, an increased length of the limb, and an increase of its circumference in the district of the joint ; and subsequently, on the head of the bone reaching the brim of the acetabulum, a shortening of the limb, as the capsule gradually yields to the action of the powerful muscles constantly tending to draw the limb upwards and backwards. There was a case in St. Bartholomew's Hospital, which I refrained from adding to the series described in this paper, because I did not at the time of its occurrence record more than its prominent features, which were as follow : - In a female, an injury to the hip from external violence was followed, first, by a lengthening of the limb to the extent of an inch, with an increase of its circumference, and subsequently by a considerable shortening, with inversion of the limb, but unaccompanied by inflammatory changes in the surrounding soft parts. In a memoir published by M. Vrolik of Amsterdam * there is an account of the examination of the hip-joint of a young female, in which dislocation of the head of the femur upwards and backwards had occurred, with elongation of the capsule and destruction of the ligamentum teres.
* Essai sur les effets produits dans le corps humain par la luxation congenitale et accidentelle non reduite du femur [Essay on the effects produced in the human body by unreduced congenital and accidental dislocation of the femur].
The acetabulum was found contracted, of a triangular form, and filled with a yellow, soft, and lobulated substance, which was apparently the adipose and cellular tissue existing naturally at the bottom of the acetabulum in a state of hypertrophy. [see 1820PallettaGB, Fig. 2 (the acetabulum of a triangular form)]
In addition to the variety of circumstances under which, in the cases
herein related, elongation of the ligaments of the hip-joint has taken place,
we may note the occurrence of such a change in early life as a consequence of
efforts repeatedly made to place the thighs in positions not permitted by the
hip-joints in their natural and healthy condition. A boy aged 18 was sent to
St. Bartholomew's Hospital, in whom the following particulars were observed. His
muscular system was remarkably well developed. When standing erect, he could,
by the action of the muscles, throw the head of either femur out of its socket
to the back of the pelvis, where it was felt projecting as in the ordinary
dislocation from external violence, and as readily, still standing erect, he
could, by renewed muscular effort, throw the head of each bone back again into
its socket. It was remarkable that with such a degree of motion in the
hip-joints, neither the firmness of his erect position, nor his power of
progression, was in any degree impaired. We learned that he had been exhibiting
feats at a country fair.
It might be suggested that in a proportion of such cases as have been
related, the primary injury was a rupture of the ligamentum teres, the yielding
of the capsule, with its attendant deformity and lameness, then in consequence
taking place. But there are several facts opposed to such a conclusion. First, we
may allude to the natural varieties in the condition of the ligamentum teres.
Often, in the adult, it consists merely of a fold of synovial membrane enclosing
no fibrous tissue, when, therefore, it can contribute very little to the
security of the joint, and on which account the office of this interarticular
ligament was thus described by Palletta in his Exercitationes Pathologice:
"Munus ligamenti aliud non esse quam illud, vasa nempe sanguinea intra
funiculi caveam dirigere eaque protegere" [The function of the ligament is
nothing but directing the blood vessels inside the cord and protecting them.].
Secondly, we may observe that in the instances of congenital deficiency of the
ligamentum teres recorded by Palletta, Bonn, Sandifort, and Caldani, it is
stated there was no lameness. Thirdly, we know that in dislocations of the hip
from external violence, the ligamentum teres is in general torn completely across
near its attachment to the head of the femur, and yet in a few weeks
afterwards, with the closure of the laceration in the capsule, the functions of
the joint are perfect; it may, I think, be safely affirmed, without are-union
of the torn interarticular ligament.
With a lengthening of the capsule of the hip-joint, it is unlikely that the head of the femur would be displaced in anу other direction than upwards and backwards, with a corresponding shortening of the limb, the action of the more numerous and powerful muscles tending to this result; and it may be presumed, that the precise situation of the head of the bone will then be between the glutueus minimus muscle and the dorsum of the ilium. An exception to. this would occur in the yielding of the capsule consequent on a paralytic condition of the muscles, when an increased length of the limb may be its permanent character, as in the second case which has been related. With the lengthening of the capsule and the passage of the head of the femur upwards and backwards to the dorsum of the ilium, there may be inversion or eversion of the limb, or no inclination of it to one or other position. Whether these differences depend on the condition of the ligamentum teres, as this may be elongated or removed, future observation must determine. It will be remarked, that in the majority of the cases which have been related, the displacement of the head of the femur occurred so gradually, and with such a freedom from uneasiness in the part, that the patient was wholly unaware that changes so important were in progress; in fact, there was no suspicion of them before the discovery that the dislocation had actually taken place. The remarkable mobility of the limb in most of these cases is also to be noticed, as another distinctive character of these displacements when contrasted with the ordinary dislocations of the hip-joint consequent on external violence, or on disease.
In illustration of the foregoing statements, I refer to two preparations contained in the Museum of St. Bartholomew's Hospital; one of these exhibits an elongation of the capsule of the hip-joint with destruction of the ligamentum teres; the other exhibits elongation of the capsule and of the ligamentum teres, with the growth of fringe-like membranous processes from the internal surface of the elongated capsule. These preparations are represented in Plate IV. Of the present volume.
Stanley E. On dislocations, especially of the hip-joint, accompanied by
elongation of the capsule and ligaments. Medico-Chirurgical Transactions. 1841;24:123-145. [ncbi.nlm.nih.gov]
Authors & Affiliations
Edward Stanley (1793-1862) was an English surgeon (St. Bartholomew's
Hospital), professor of human anatomy and physiology, was president of the Royal
Medical and Chirurgical Society. [wikipedia.org]
 |
| Edward Stanley (1793–1862) The author of the bust John Graham Lough; Barts Health NHS Trust Archives and Museums, image copied from artuk.org website (CC BY-NC, no changes) |
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur,
hip dislocation, pathological anatomy, lengthening, absence, observation
.
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
EXPERIMENTS AND OBSERVATIONS
Comments
Post a Comment