1855WalbaumCFE

 

The author reports the presence of blood vessels in the ligamentum capitis femoris (LCF), and its mechanical significance in the prenatal period. In addition, Karl Walbaum notes the presence of two bundles in the LCF, originating from the acetabular notch, and the involvement of the ligament in restricting hip adduction. Information about the author is very limited. All that is known about him is gleaned from the bibliographic reference provided in the dissertation.

The translation was done in collaboration with ChatGPT 3.5. 

Walbaum C.F.E. De arteriis articulationis coxae: Diss. inaug. med. Lipsiae: B.G. Teubneri, 1855. [fragments]
Quote pp. 9-13
Venio nunc ad arterias acetabuli, ligamenti teretis, limbi cartilaginei et tegumentorum cartilagineorum; quantum ad telas cartilagineas articulationis eae arterias non habent ut reliquae cartilagines corporis; ceterae telae omnes arterias suas ex arteria obturatoria accipiunt. Arteria obturatoria normaliter ex arter. hypogastrica, anomaliter ex art. crurali vel epigastria oritur; priusquam foramen obturatorium transit ramos ad ossa pelvis mittit et saepe ramos qui eum art. obturatoria altera communicant; transit deinde cum ramo profundo nervi obturatorii foramen (Fig. II, e.) apparetque supra marginem superiorem musculi obturatorii externi; hic in ramos duos maiores dividitur, in superiorem et profundum; superior (Fig. II, g.) musculos adductores potens hue non pertinet; ramus profundus musculo obturatorio obtectus, quum ad incisuram acetabuli venit, arteriam acetabuli mittit. Limbus cartilagineus incisuram transit formatque hoe modo canalem, per quem arteria venit, quo in transitu saepe quoque ante transitum in arteriam foveae (Fig. I, d.) et arteriam lig. teretis (Fig. I, e.) dividitur. Iam vero, ut cursum earum porscribam, de origine naturaque ligamenti et foveae pauca dicenda sunt. Fovea oritur ab incisura, vel potius continuatio eius est, regionem autem acetabuli internam occupat eiusque profundum attingit; quod pertinet ad ambitum, paullo minor est tertia parte totius acetabuli; altitudo non ubique eadem est; tegumentum cartilagineum mon habet, praecipue autem pingui completa atque membrana synoviali obducta est; glandulas item in ea non videmus, sed plicas vasculosas, quas supra dixi; fovea est refugium ligamenti teretis. Ligamenti teretis altera pars fibrosa est, altera serosa (tegumentum synoviale); pars fibrosa praecipue a margine inferiore incisurae acetabuli oritur; origo eius a margine superiore continuatione membranae synovialis ligamenti teretis ad foveam efficitur; inter haec duo crura. originis ligamenti art. acetabuli intrat et dividitur. Art. foveae, quao maior est arteria ligamenti, in III. — V. ramos divisa partem eorum et quidem maiorem ad ossa acetabuli, partem minorem ad pingue et membranam synovialem huius loci mittit; ramos circiter 1/4 — 1/6''' latos esse puto. Vasa ligamenti teretis, ramificationes dico arteriae ligamenti, non multum infra indumentum serosum iacent et quidem in eo latere, quod in foveam versum est; rami, quos numero III — IV inveni, circiter 1/6 — 1/8''' lati erant; nonnulli eorum plicas vasculosas effciunt, quas supra dixi (Fig. III.). De arteriis huius partis sententiae sunt variae; alii arterias in caput transire, alii (Hyrtl, topographische Anatomie, Vol. II. p. 331) hoc non ita esse putant. Iniectiones varias feci et quidem in cadaveribus et iuvenilium et senilium hominum. Primum substantiam rubram (Mennige etc.) in art. cruralem inieci, vasa autem usque ad medium ligamentum tantum completa erant; iniectione secunda (Chromgelb etc.) ex eo loco facta, quo aorta abdominalis dividitur, arteriis cruralibus, epigastricis et cireumflexis ilei subligatis, vasa plane erant completa. Quae quidem vasa facilius quam antea censebam usque ad insertionem ligamenti persequi potui, et quum deinde collum et partem capitis serra ceteraque scalpro ea regione discidissem, qua transitum arteriarum esse conieceram, hoe loco quo ligamentum inseritur infra ipsam lamellam tenuem foveolae arterias subtiles, substantia qua usus sum, completas inveniebam (Fig. I, f). Quamquam omnia perscrutatus sum, arterias ab imo venientes, quibus illae completae esse potuissent, non vidi. In arteriam obturatoriam collam cocco tinctam inieci, per anastomoses vero arteriam profundam eiusdem lateris et art. obturatoriam alterius lateris completas inveni. Videmus, quam difficile sit, in arterias singulares substantias varie coloratas iniecere, nam anastomoses omnes subligare non possumus. In arteriam acetabuli substantiam iniücere non potui. Reliquae iniectiones, quas feci eundem exitum habuerunt quem secunda iniectio. Aliis quoque de causis vasa transire arbitror; in lamella enim tenui foveolae capitis, praecipue in osse macerato, multa foramina subtilia videmus, quorum per partem vasa penetrare possunt. Deinde telae fibrosae vasa pauca habent; hie quoque in ipsa fibrosa parte ligamenti non multa vidimus, eaque non multum infra indumentum synoviale iacere iam diximus; si vero vasa omnia ligamenti secretioni destinata essent, illuc secretionem auctam vel compositione alienatam esse putare deberemus; utrumque non licet. Nelaton (Nelaton, Elemens de Pathologie chirurgiale. p.780. 1) adeo dicit praecipuam ligamenti utilitatem osse vasa tuendi, et lig. teres mesenterium appellat; hoc non ita se habet, nam ligamento nimiam adductionem prohiberi videmus. Summus vero usus mihi videtur esse foetalis; triplicem enim diametrum pro magnitudine totius corporis obtinet in foetu, ne retro caput luxetur tam faustis conditionibus. Nescio an non aliud animal in tali positione feratur in utero, quali homo, si non, nemo mirabitur quod in solo homine illud inveniamus. Multum laboravi, ut transitum continuum arteriarum ex ligamento in caput viderem, sed frustra; mox substantia iniicienda minus erat subtilis, mox minore vi iniecta erat, mox os in aliam directionem diripiebatur, aique eam qua vasa intrant; serra enim aspectus oblinebatur. Cursus angulatus et flexus arteriarum, aeris pondus certe mihi non incommodo fuere, ut in vivo cursum sanguinis non prohibent. Iam afteria acetabuli, arteriis in musculos obturatiorium externum et adductores emissis, ramus terminalis art. obturatoriae ad superficiem internam capsulae fibrosae vertitur, hinc in membranam synovialem capsulae fibrosae inhaerentem ramos mittens, tandem decurrit sub inflectione membranae synovialis, iacet in plicis longitudinalibus, perforat os et in capite ramificatur (Fig. k. et k').	I now come to the arteries of the acetabulum, rounded ligament, cartilaginous margin and cartilaginous membranes; as for the cartilaginous tissues of the articulation, they do not have arteries, like the rest of the cartilage of the body; all other tissues receive their arteries from the obturator artery. The obturator artery usually arises from the iliac artery, sometimes from the femoral or epigastric artery; before it crosses the obturator foramen, it sends branches to the bones of the pelvis and often branches that connect it to the other obturator artery; it then passes through the obturator foramen along with the deep branch of the obturator nerve (Fig. II, e) and appears above the superior edge of the obturator externus muscle; here it is divided into two large branches, upper and deep; the superior branch (Fig. II, g) is not part of the adductor muscles; the deep branch, passing to the notch of the acetabulum, gives off the acetabular artery. The cartilaginous limbus crosses the notch and thus forms a canal through which the artery passes; in its passage, before branching into the artery of the pit (Fig. I, d.) and the ligamentum teres (Fig. I, e.), it divides into two parts. Now, to describe their course, we need to say a little about the origin and nature of the ligament and the pit. The fossa arises from the notch, or rather, is a continuation of it, occupies the inner region of the acetabulum and reaches its depth; that which refers to the circumference is slightly less than a third of the entire acetabulum; the height is not the same everywhere; has a cartilaginous cover, but is predominantly filled with fat and covered with a synovial membrane; Again, we see in it not glands, but the vascular folds that I spoke about above; the fossa is the refuge of the rounded ligament. One part of the rounded ligament is fibrous, the other is serous (synovium); the fibrous part begins mainly from the lower edge of the acetabulum notch; its beginning from the upper edge is a continuation of the synovial membrane of the rounded ligament to the fossa; Between these two legs of the beginning of the ligament, the acetabulum artery enters and divides. The artery of the fossa, which is larger than the artery of the ligament, is divided into III. - V. branches, most of which are directed to the bones of the acetabulum, and the smaller part - to the adipose tissue and synovial membrane of this place; I'm guessing the branches were about 1/4 - 1/6'' wide. The vessels of the rounded ligament, which I call the branches of the artery of the ligament, are located slightly below the synovium on the side that faces the fossa; the branches, which I found in quantities III - IV, had a width of about 1/6 - 1/8'''; some of them form vascular folds (loops), which I already mentioned above (Fig. III). There are different opinions about the arteries of this part; some believe that the arteries pass into the head of the femur, others (Hyrtl, topographische Anatomie, Vol. II. p. 331) do not share this opinion. Indeed, I have given various injections to the corpses of both young and old people. First, the red substance (Mennige, etc.) into the artery of the leg, and the vessels were filled only to the middle of the ligament; with the second injection (Chromgelb and others) from the site of division of the abdominal aorta, after ligation of the femoral, epigastric and iliac arteries, the vessels were completely filled. I was able to follow these vessels more easily than I had previously thought, right up to the attachment of the ligament, and then I, having divided the neck and part of the head with a saw and other instruments, in the area where I supposed the arteries to pass, in the place where the ligament is attached below a very thin plates of the fossa, I found the thin arteries, according to the substance I used, intact (Fig. I, f). Although I searched everything, I did not see any arteries coming from below, with which they could be completed. I injected the coconut substance into the obturator artery, and found that through the anastomoses, the deep artery on this side and the obturator artery on the other side were completely filled. We see how difficult it is to inject various colored substances into individual arteries, since we cannot ligate all the anastomoses. I was unable to inject the substance into the acetabulum artery. The other injections I gave had the same result as the second injection. I believe that vessels pass for other reasons; on the thin lamella of the head's fossa, especially in macerated bone, we see numerous small openings through which vessels can penetrate. Additionally, fibrous tissues have few vessels; we've already mentioned that in this ligament area, we see few vessels, and they lie slightly below the synovial membrane; if all the vessels were intended for secretion by the ligament, we would have to assume that secretion there would be increased quantitatively or altered in composition; but neither of these assumptions is permissible. Nelaton (Nelaton, Elemens de Pathologie chirurgiale. p.780. 1) even says that the main advantage of the ligament is to protect the bone vessels, and calls the round ligament the mesentery; this is not the case as we see that the ligament prevents excessive adduction. But its most significant function seems to be in the fetus; for in the fetus, it has a diameter three times greater than the size of the whole body, so that the head does not move backward under such favorable conditions. I do not know whether any other animal is in the womb in such a position as man; if not, then no one will be surprised that we find it only in humans. I labored hard to see the continuous course of the arteries from the ligament to the head, but without success; the substance that I injected was sometimes less thin, sometimes it was introduced with less force, then the bone was broken in a different direction, not where the vessels entered; because the saw blade made it difficult to see. The bends and kinks of the arteries certainly do not interfere with the blood flowing freely in a living organism. Now regarding the artery of the acetabulum, after the arteries were directed to the external obturator and adductor muscles, the terminal branch of the external obturator artery turns towards the inner surface of the fibrous capsule, then sends branches into the synovial membrane of the fibrous capsule, finally passing under the fold of the synovial membrane, lying in longitudinal folds, penetrating through the bone and branching into the head (Fig. k and k').
Quote p. 17
Nelaton (Nelaton de Pathologie chirurgiale; p. 780. 1) vasa transire in caput eaque sufficere nutritioni callique formationi docet; conclusio eius deducta est primum ex satis cognitis osseae consolidationis casibus, deinde ex iis observationibus, quae ostendunt, partem superiorem non gangraenescere; denique putat summam ligament teretis utilitatem eo cerni, quod vasa servet, tanquam mesenteriolum; quam opinionem Petrequin (Petrequin p. 449.) secutus est.	Nelaton (Nelaton de Pathologie chirurgiale; p. 780. 1) asserts that the vessels pass into the head and are sufficient for the nutrition and formation of the callus; his conclusion is based firstly on well-known cases of bone fusion, and then on observations showing that the upper part of the femur (the head) is not subject to necrosis; finally, he believes that the main benefit of the rounded ligament is that it protects the vessels, akin to a mesentery; this opinion was also held by Petrequin (Petrequin p. 449.
Quote p. 18
Cooper (Cooper. Vol. II. p. 201.) nusquam osseam consolidationem fracturae íntracapsularis se invenisse dicit; pagina 265. doeet fractura colli femoris paene nullam inflammationem excitari, partem superiorem sanguinem ex vasibus ligamenti teretis accipere, quae non sufficiant ad callum secernendum, ita ut sola ligamenta formentur, ut in fracturis patellae, condylorum ossis humeri, oleerani, processus coronoidei, quum intra capsulam frangerentur; hanc sententiam Malgaigne (Malgaigne, Anatomie chirurgiale, p. 417.) secutus est. Hyrtl denique (Hyrtl, topographische Anatomie, Vol. II. p. 331.) ligamento terete vasa ad caput deduci omnino negat; primum enim numquam se talia vidisse, deinde extra regulam illud ligamentum apud multa mammalia esse, denique intelligi non posse dicit, quo modo rupto ligamento, ossibus luxatis, caput tam diu nutriatur. Quod si docet in multis mammalibus illud ligamentum non inveniri, hinc non colligendum est vasa ligamenti, quod in hominibus invenitur, non transire ad caput; quantum ad rupturam, osse luxato, pertinet, iam supra commemoravi arterias synoviales collum perforantes usque ad medium caput et altius ascendere, idque nutrire posse. Praeterea illi casus, in quibus ossea coniunctio orta est, quorumque nonnullos enumerabo, sufficientem sanguinis affluxum manifestant.	Cooper (Cooper. Vol. II. p. 201.) states that he has never found bone consolidation in intracapsular fractures; on page 265, he mentions that a fracture of the femoral neck should cause almost no inflammation, with the upper part receiving blood from vessels of the rounded ligament, which are insufficient for callus formation, resulting only in fibrous tissue, as seen in fractures of the patella, condyles of the humerus, olecranon, coronoid process, when the fracture occurs within the capsule; this view was followed by Malgaigne (Malgaigne, Anatomie chirurgiale, p. 417.). Hyrtl, in the end (Hyrtl, topographische Anatomie, Vol. II. p. 331.), completely denies that vessels reach the head through the round ligament; firstly, he has never observed such a phenomenon, secondly, this ligament is found in many mammals, and finally, he argues that it is impossible to understand how the head bone can be nourished for so long after the ligament is torn and the bone is dislocated. If he demonstrates that in many mammals such a ligament does not exist, this does not mean that the vessels of the ligament, which are present in humans, do not reach the head; as for the dislocation of the bone after rupture, I have already mentioned the synovial arteries running through the neck to the middle and above the head, which, as I maintain, can provide nutrition. Moreover, those cases in which bony union occurs, a few of which I will mention, demonstrate sufficient blood flow.
Quote p. 19
CASUS. II. **) Medicus anglicus 47 a. natus, novem mensibus post colli femoris fracturam mortuus est; capsulam crassiorem, quam solet esso, acetabulum et ligamentum teres integrum, collum brevius, in basi capitis multum callum invenerunt. **) Brulatour im Journal v. Walther u. Graefe. Bd. XII. p.417.	CASES. II. **) An English physician, 47 years old, died nine months after a femoral neck fracture; upon autopsy, a thicker than usual capsule of the hip joint, intact acetabulum and round ligament were found, and a significant amount of bone growth was detected on the short neck and at the base of the head. **) Brulatour in the Journal of Walther and Graefe. Vol. XII. p.417.
Quote p. 20
VI. **) In homine 80 a. nato capsula paullo crassior, omnes telae circa articulum pallidiores erant; lig. teres plenum erat vaseulis, firmitate regulari; Colli fractura erat transversalis, osse consolidata. **) Condit in New Jersay Medical Reporter. April 1848, und. London Medical Gazette Vol. VIII, 1849. p. 202.	VI. **) In an 80-year-old individual, the capsule was slightly thicker, all tissues around the joint were paler; the round ligament was filled with small vessels and had normal strength; the neck fracture was transverse, and the bone had healed. **) Condit in New Jersay Medical Reporter. April 1848, und. London Medical Gazette Vol. VIII, 1849. p. 202.
Quote p. 22
Plicae longitudinales, nimis firmiter ossi adhaerentes, loco suo cedere possunt, inque fracturis colli femoris minus rumpuntur, quo quidem arteriae conservantur. Arteriae ergo ligamenti teretis, quamquam plane non dubito, quin transitu facto callificationis participes esse possint, id quod praecipue casus VI. docet, ubi vidimus ligamentum vasculis plenum fuisse, tamen ad sanationem fracturae colli femoris non tantum valent, quantum olim putabatur.	Longitudinal folds, adhering too firmly to the bone, may displace from their position, and in fractures of the femoral neck, they are less likely to rupture, thus preserving the arteries. Therefore, the arteries of the round ligament, although I have no doubt that they can participate in the process of calcification, which is especially confirmed by case VI, where we saw that the ligament was full of vessels, are still not as effective in healing femoral neck fractures as previously thought.

 External links

Walbaum C.F.E. De arteriis articulationis coxae: Diss. inaug. med. Lipsiae: B.G. Teubneri, 1855. [books.google]

Authors & Affiliations

Carolus (Karl) Ferdinand Erich Walbaum from Weimar (born in 1830)

The surgical dissertation was defended on May 12, 1855, at the University of Halle-Wittenberg (Vereinigte Friedrichs-UniversitätHalle-Wittenberg). The author studied at the University of Jena and the University of Leipzig, mastering dissection under the supervision of the brothers E.H. Weber and Ed. Weber.

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, role, significance, blood supply

                                                                                                                    

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