Selected fragments of the book Bell J. The Principles of Surgery (1801). The author discusses hip injuries and the mechanism of ligamentum capitis femoris (LCF) injury. Bell's drawing and reasoning probably led 1823GerdyPN to consider the role of LCF tension in hip dislocation.
Quote pp. 523-524
The acetabulum
or socket for the thigh bone is formed in the centre of the greatest and firmest
bone of the pelvis, named os innominatum, from its irregular shape. It is in
the adult the largest and firmest bone of the pelvis, but in the child it is
formed of three distinct bones, the Ilium, Ischium, and Pubis. These are joined
by an intermediate cartilage, and are easily separated into distinct bones. At
an early age this cartilage is prominent, and somewhat of a triangular form.
The cartilage is ossified in the adult, and it being ossified, becomes more
prominent, and makes a high triangular projection in the centre of the socket;
this prominence gives a firmer connexion to that thin cartilage which lines in
a more general manner the cavity of the socket; it is here also at this prominence
in the centre of the socket that the central ligament is fixed, which, although
it is named the round ligament, is (especially at its root) of a triangular form.
The bones, which compose the acetabulum, are not inseparably joined even at the
twentieth year; it has been affirmed, that by a violent blow on the trochanter,
driving the head down into the acetabulum, those three bones have been burst asunder!
I strongly suspect that it is the imperfect ossification in the centre of this
joint that makes the acetabulum so often in boys the feat of disease.
Quote pp. 574-575
The first
plan that I lay before you, is such a scheme of the hip joint as will explain
decidedly the effects of blows or falls in various directions. (a) Marks the deepest
part of the socket which entirely receives the round head of the thigh bone,
and upon this point the whole weight of the body rests. (b) Next marks the head
of the thigh bone raised and turned a very little out of its acetabulum, in
order to show the hollow of the acetabulum and the root of the round ligament.
(c) Marks the round ligament which arises rather from the lower margin of the socket,
and which prevents the head from starting out of the socket, or being at all
luxated till this ligament is burst; and indeed it would seem as if the weight
of the body were in some degree supported by this strong ligament, though the
weight is chiefly balanced upon the head of the thigh bone. (d) Marks that deep
part of the socket where the mucous ducts and fatty simbriæ lie, and where the
inside lining of the capsule is most peculiarly delicate; and since the body hangs
by the upper part of the socket on the top of the thigh bone, this delicate apparatus,
lurking in a small dimple at the lower part of the socket, escapes all dangerous
pressure, and is but gently moved as the central ligament moves.
With the
plan of the joint thus before us, nothing is more easy than to judge, with almost
mathematical precision, of the effects of each particular blow or twist. 1st,
In the perpendicular posture of the body, when the pelvis rests fairly on the head
of the thigh bone, the neck of the thigh bone bears its full share of the weight;
and in falling from a height upon the feet, or in dropping from a window †, or
in falling with force upon one knee, or in taking a high and dangerous leap,
the whole weight of the body strikes upon the head of the thigh bone in a direction
transverse to that of the neck. The resistance of the ligament from below, and
the deepness of the socket above, prevents luxation upwards, and the neck of the
bone breaks across. The direction of such a shock is indicated by the dotted
line (1). A blow in this direction, then, may fracture the neck of the thigh
bone, or may so bruise the socket, as to produce a disease like that of boys
(vide foot note, page 572.) but can never hurt the lubricating apparatus, which
is safely lodged at (d), where no pressure is.
2d, A fall
in which the foot flips inwards, the limb is twisted , and the body falls on
one fide ; in short , when the thigh is distorted in the direction marked by
the dotted line (2 ) ; the head of the bone is more frequently twisted out of its
socket, and luxated upwards ; the great capsule of the joint is burst ; the central
ligament is torn up by its root ; and the head of the femur is lodged on the back
of the haunch bone, or in the sciatic notch.
3d, But
when the person flips his foot, so that the inside of the ancle slides along
the ground, and that the limb is twisted outwards ; or when having a heavy burden
on his back, he falls , so that the inside of the knee strikes the ground; or
when, as in laying a sack of corn from his back upon a cart, he makes one step
away from the cart, and the sack falls upon his extended leg, so as to twist the
limb outwards; then the thigh bone comes into the direction denoted by the dotted
line (3), the head of the thigh bone is turned downwards towards the lower part
of the socket, and is easily luxated in that direction, because there the socket
is imperfect, its border is low and guarded only by a ligament (the ligamentum
labri cartaliginei) , while the central ligament prevents only luxation upwards,
because its root arises near this lower border of the acetabulum.
4th, It is
very obvious, that when the thigh bone is struck in the direction of the dotted
line (4) by a fall upon the trochanter, its head is beaten down into that part of
the socket where the mucous ducts lie, and these soft parts are bruised, whence
comes immediate and dreadful pain, high inflammation in the joint, and sometimes
suppuration and caries of the acetabulum, followed by anchylosis.
5th, When
the great trochanter is struck obliquely from above downwards in the direction
of the dotted line (5), any of all those accidents may ensue, for the head of
the bone is struck so downwards into the socket, that very frequently the mucous
ducts are injured; or being struck thus obliquely, the head of the bone may be
luxated downwards, by being driven over the border of the acetabulum at its shallowest
part; or, finally, by being struck thus obliquely, the neck itself may be
broken.
External links
Bell J. The Principles of Surgery: In Two Volumes: Volume First; Of the ordinary duties of the surgeon, containing the principles of surgery, as they relate to wounds, ulcers, and fistulas, aneurisms, and wounded arteries, fractures of the linbs, and the duties of the military and hospital surgeon. …. Edinburgh: Printed for T. Cadell, jun. [and others], 1801. [books.google , anatomia.library.utoronto.ca , archive.org]
Authors & Affiliations
John Bell (1763-1820) was a Scottish anatomist and surgeon. [wikipedia.org]
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| John Bell (circa 1801) Unknown author, original in the wikimedia.org collection (CC0 – Public Domain, color correction). |
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, dislocation, role, damage, mechanism, scientific synonym
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MECHANISMS OF DAMAGE
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