Fragments of the book
Dupuytren G.
On the injuries and diseases of bones (1847) dedicated to ligamentum capitis femoris
(LCF). The author
briefly discusses changes in the LCF in hip dysplasia and its role in supplying
blood to the femoral head.
Quote p. 173
CHAPTER X.
ORIGINAL OR CONGENITAL DISPLACEMENT OF THE HEADS OF THIGH-BONES.
…
The upper part of the
thigh preserves, in these cases, its natural form and dimensions, with the
single exception of the upper and inner part of the head of this bone, which I
have remarked has sometimes lost a little of its roundness, a circumstance
which appears due to the friction it has been subjected to, by contact with a
surface unsuited for articulation. The cotyloid cavity is either altogether
absent, or presents only a small osseous, irregular prominence, where neither
trace of diarthrodial cartilage nor vestige of synovial or other capsule, nor
fibrous margin is to be found; but which is surrounded by some tough cellular
tissue, and covered by the muscles which are inserted into the smaller
trochanter. Once, in two or three subjects which have been submitted for my
examination, I met with the round ligament of the joint very much elongated,
flattened above and, as it were, worn at certain points by the pressure and
friction of the head of the femur.
Quote pp. 179-180
Case I. Original
dislocation of the ossa femoris. Retention of urine, terminating fatally;
autopsy.
…
On the left side, the original cavity did not measure more than an inch at its greatest diameter; it was very shallow, rugged, and filled with a fatty substance of a yellowish colour, and almost of the fluidity of oil; its form was nearly an oval. The external iliac fossa presented, in front of the sciatic notch, a broad, shallow depression, lined by a thick glistening periosteum, which had almost the appearance of articular cartilage: it was on this that the head of the femur rested. The last-mentioned process itself was diminished in volume, a little flattened, irregular, and without any vestige to mark the attachment of the round ligament; it was, nevertheless, invested by articular cartilage which was thinner than natural. The fibrous capsule of the joint, which was in form exactly like a purse, was attached to the upper and lower borders of the original acetabulum, and was in place of an osseous cavity on the side it covered; its length was sufficient to allow the ascent of the head of the femur to the depression I have just described: the space over which it extended amounted to about three inches. This capsule was very thick, and almost as dense as cartilage.
Quote pp. 208-209
CHAPTER XI.
FRACTURES OF THE NECK OF THE FEMUR, THEIR CAUSES AND TREATMENT.
…
I must, however,
admit, that an examination of the preparations alluded to, and which so
convincingly prove the reality of bony union in cases of intra-capsular
fracture, does not seem to have satisfied other English surgeons who have
visited the museum of our faculty. After a careful consideration of the
specimens preserved in the Ecole de Medecine of Paris, Mr. Cross remarks,
"none of these specimens, therefore, proved to me, that bony union ever
follows the fracture of the neck where the head of the bone becomes isolated,
except at its attachment to the pelvis by the ligamentum teres."(1) I can
only say, for my part, that if the specimens at the Hotel-Dieu are insufficient
to satisfy any one who may take the trouble to examine them, I am at a loss to
know what amount of evidence such sceptics would require. For my part, I regard
the osseous union of intra-capsular fracture of the neck of the thigh-bone as
demonstrated, and placed beyond doubt.
1. Sketches of the
Medical School of Paris, p. 93.
As many practical and
theoretical reasons have been adduced for and against this union, I shall
briefly state them. It has been asserted, in the first place, that the upper
fragment, in these fractures, contains but few or no vessels, and that it
really stands in the relation of a foreign body to the joint: but this is
erroneous, as vessels pass to the head of the bone along the round ligament,
and arc sufficient for the purposes of nutrition. Of the abundant supply to the
lower fragment there can be no reasonable doubt; and upon it the principal work
of consolidation falls: though, as already remarked, the upper fragment
contributes something towards this result. It has, again, been affirmed that
the neck of the femur is devoid of periosteum; but this is likewise untrue it
is certainly thin and delicate at this part, but still it is present, and
cannot be reckoned amongst the insurmountable obstacles to union of a fracture
in this position. Another objection which has been raised is, that the synovia
in which the fragments are constantly bathed must render consolidation impracticable.
This difficulty might appear more plausible, were it not well known that a
similar condition offers no obstacle to the union of fractures involving other joints,
such as the elbow and knee, in cases where the olecranon or patella is broken. No
one doubts the possibility of such fractures being directly united: I have
myself witnessed instances, one of which occurred some years since, and in
which I afterwards had the opportunity of demonstrating the direct union of a
fractured patella, without deformity of any sort. The fact is that the great
difficulty lies in the perfect and accurate adjustment and relation of the
fractured ends of the bone.
Quote p. 221
Case IX. Fracture of
the neck of the left thigh-bone; chronic enteritis, and death.
…
On examining the body
of this patient, serum was found poured out into the pleural cavities; the
lower part of the large intestine presented some points of ulceration; and the mucous
lining of the womb was inflamed, &c. The head of the femur was separated
from the shaft, and lodged in the acetabulum, the fracture having been at the
junction of the body and neck: the latter was quite destroyed by caries. There
were no traces of the cartilage of the articular cavity and there was also
partial erosion of that on the head of the femur; but the osseous surface of
the latter was not at all involved, whereas, in the acetabulum it was rough and
dark. The round ligament was also entirely destroyed, and there was no
appearance of synovial membrane: the capsule was perforated at several points.
In the interstices of the muscles at the upper part of the thigh, and around
the joint, there were several collections of dark purulent fluid. The muscular tissue
was itself of a dark brown colour; and the uniting areolar tissue was either
altered in character or destroyed.
Dupuytren G. On the injuries and diseases of bones: being selections from
the collected edition of the clinical lectures of baron Dupuytren. London: Sydenham
Society, 1847. [archive.org
, books.google]
Authors & Affiliations
Guillaume Dupuytren (1777-1835) was a French anatomist and military surgeon. [wikipedia.org]
_CIPN21547.jpg) |
| DUPUYTREN (Guillaume) Source: Corlieu (A.), Centenaire de la Faculté de Médecine de Paris (1794-1894), Paris: F. Alcan, 1894; original in the wikimedia.org collection (CC0 – Public Domain, no changes) |
Keywords
ligamentum capitis femoris, ligamentum teres, ligament
of head of femur, vascularization, fracture, dysplasia, blood supply, elongation
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