1873AdamsR

 

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] 

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

                                                                    

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