Fragments
from the book Adams R. A treatise on rheumatic gout, or chronic rheumatic
arthritis of all the joints (1873). The author discusses pathological changes
in the ligamentum capitis femoris (LCF) in chronic osteoarthritis of the hip
joint.
Quote p. 62
CASE III.
CASE OF FRACTURE OF
THE NECK OF THE FEMUR, AT ITS BASIS, WITH DETACHMENT OF BOTH TROCHANTERS FROM
THE SHAFT OF THE BONE, IN A PATIENT WHO HAD BEEN FOR A LONG TIME PREVIOUSLY TO
THE OCCURRENCE OF THE ACCIDENT SUBJECTED TO CHRONIC RHEUMATIC ARTHRITIS OF THE
HIP.
Patrick Doolan, aged
75, was admitted into Jervis-street Hospital, February 17, 1831, labouring
under a severe injury of the hip-joint.
…
Quote pp. 64-65
On making a
post-mortem examination, it was found: 1st. That a fracture of the cervix
femoris had occurred at its root, close to the trochanters. 2ndly. That the
great trochanter, which was much increased in size, was broken off obliquely
from the shaft of the femur; the fracture ran in such a direction as to detach
the trochanter from the shaft of the bone, leaving attached to the former the
insertions of the pyriformis, gemelli, obturatores, and quadratus femoris.
3rdly. The trochanter minor was also broken off, so that the psoas magnus and
iliacus had lost all connexion with the femur.
The capsular ligament
was found thickened; and when this was freely cut all round, it required the
exertion of much force to pull the head of the femur from the socket. The
ligamentum teres had entirely disappeared. The cartilage of the head of the
bone was almost altogether absorbed, and in its place was deposited a complete
enamel resembling ivory, smooth and polished. The head of the bone was altered
in shape it was larger than natural, and flattened on its upper surface; a
quantity of bone was deposited all round the head of the femur, where it joins
the neck of this bone.
The acetabulum was greatly enlarged, and lined by the same material as that covering the head of the femur; there was no trace of the substance called Haversian gland, and the pit for its reception had entirely disappeared. When the fractured portions of the bone were restored to their original position, it was found that the neck of the femur was quite horizontal, and that from this cause, and from its increased size, the trochanter major was situated above the level of the head of the bone.
Quote p. 67
ANATOMICAL CHARACTERS.
In the first part of this work,
when referring to those by whose exertions we have been made acquainted with
the pathological anatomy of this disease as it affects the bones of the
hip-joint, I have adduced the name of Edw. Sandifort of Leyden, as the earliest
contributor to our knowledge on this subject. He, in the second volume of the
"Museum Anatomicum," published in 1793, has given delineations of
some diseased bones of the hip-joint preserved in the celebrated Museum at
Leyden.
Quote p. 70
In advanced cases no traces of the ligamentum teres, nor of the mass called Haversian gland, exist in the acetabulum. These, together with the cartilages of incrustation which line this articular cavity, are altogether removed, as well as the compact layer of bone which these structures had covered; the cells of the bone, thus exposed, yield to weight and pressure, and become so deeply worn away, that the Haversian fossa is effaced, and the acetabulum becomes converted into a deep cup or excavation, capable of containing the enlarged head of the femur.
Quote pp. 77-78
Professor Smith, for
example, has called attention to a specimen contained in the Museum of the
College of Surgeons, Dublin. The preparation consists of the pelvis and thigh
bones of a female, aged 60.
"The heads of
both femora (although presenting some of the characteristic appearances of the
result of chronic rheumatic arthritis) are diminished in size; that of the
right is slightly elongated. The surface exhibits a very trifling degree of
enamelling, and is, as it were, drilled with an infinite number of small
foramina, many of which penetrate to a considerable depth. The acetabula are
equally porous, and out of all proportion larger than the heads of the thigh
bone. The increase in size is partly effected by osseous additions to their
free margins, and partly by a protrusion of their inner walls into the cavity
of the pelvis, where they form two hemispherical bulgings, which diminish the
transverse measurement of the pelvis by at least one inch. The bone in this
situation is exceedingly thin, and quite diaphanous. It is remarkable that in
the joint of the left side the ligamentum teres was present, in a very strong
and perfect state, the synovial portion being alone deficient. The absence of
porcellaneous deposit on the opposed surfaces of this side may be, perhaps,
accounted for by the fact of the patient having been for years confined to bed,
during which time, consequently, there was little or no friction between
them."*
* Dr. Houston's Catalogue of the Museum of the Royal College of Surgeons in Ireland: vol. I., p. 379.
Quote pp. 88-89
Latterly, Dr. Percival
could not prevent his right leg from crossing over the left; in this position
he found ease from suffering, and to remove the limb from it gave him
considerable pain. When he sat in this attitude, he felt tolerably free from
uneasiness, and he could gradually raise himself nearly to the erect posture
without much suffering, provided he did so slowly, cautiously moving the pelvis
on the head of the femur. These slow and cautious movements from the sitting to
the erect posture did not give pain, and he frequently called the attention of
his medical attendant to the very loud crackling noises they occasioned. He had
all the ordinary rational signs of the disease, the shortening and eversion of
the limb, and the characteristic walk. There was considerable difference
between the date of the right hip-joint having become affected and that of the
left, which was not implicated in the same diseased action until the year 1834.
The appearances of the joint as exhibited by Dr. Colles were quite characteristic of the disease: there was the usual flattening of the heads of the bones, the ivory deposit replacing the absorbed cartilage; a similar deposit on the acetabulum; total absence of the ligamentum teres; shortening of the neck of the femur; and osseous depositions in various situations. One of these lay in front of the right acetabulum, and the anterior crural nerve, flattened and redder than natural, passed over it: this appeared to Dr. Colles to explain the great amount of suffering experienced by Dr. Percival during the latter part of his life he could not prevent the right limb from crossing over the left, &c. &c. The right limb was shorter than the left. Upon removing the left femur from the socket, the head of the bone was found intensely red and vascular, and a number of small pieces of bone were found connected with the capsule; there were none loose in the joint, as was supposed from the very peculiar grating or rattling sound heard during life, whenever the limb was moved; both thigh bones were found to be remarkably heavy and dense.
Quote p. 171
"In confirmation of this view of the case it may be mentioned, that in the body of the person in whom these specimens were found all the fingers and toes were webbed, and that one of the hip-joints presented a well-marked example of chronic rheumatic arthritis, evidenced by the disappearance of the ligamentum teres; the removal of the articular cartilage; the existence of an ivory-like deposit; and, finally, by shortening of the neck of the femur, and an alteration in the angle which it naturally forms with the shaft."*
* Dublin Quarterly Journal of Medical Science, February, 1853.
External links
Adams R. A
treatise on rheumatic gout, or chronic rheumatic arthritis of all the joints. London:
John Churchill, 1857. [archive.org]
Adams R. A
treatise on rheumatic gout, or chronic rheumatic arthritis of all the joints. 2nd
ed. London: John Churchill, 1873.
[books.google]
Authors & Affiliations
Robert Adams (1791-1875) was an Irish surgeon and was three times President of the Royal College of Surgeons in Ireland. He taught at Richmond Hospital Medical School and Carmichael School of Medicine. [wikipedia.org]
.jpg) |
| Robert Adams Catterson Smith, R.H.A. pinx. J.H. Lynch, Lith.; original in the collections.nlm.nih.gov, see also wikimedia.org collection (CC0 – Public Domain, fragment) |
Keywords
ligamentum capitis femoris, ligamentum
teres, ligament of head of femur, pathological anatomy, osteoarthritis,
destruction
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
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