Content
Fragment from the book: Harrison R. The Dublin
Dissector, Or Manual of Anatomy: Comprising a Description of the Bones,
Muscles, Vessels, Nerves, and Viscera; Also the Relative Anatomy of the
Different Regions of the Human Body, Together with the Elements of Pathology (1840).
The author describes the anatomy, topography, dimensions, attachment, and role
of the ligamentum capitis femoris (LCF), and discusses its injury in hip
dislocations. The text in Russian is available at the following link: 1840HarrisonR.
Quote pp. 518-521.
The
cotyloid ligament may be next noticed, this is the fibro-cartilaginous lip
which deepens the acetabulum, and at the same time narrows its orifice, so as
to hold or retain the head of the femur even after the capsular ligament and
all the muscles have been divided; it is composed of strong circular fibres,
these pass in deeper in those particular situations where the acetabulum in
infancy was separable into three parts; it serves to deepen the cavity, and to
prevent the neck of the femur striking against the sharp edge of the cavity.
Transverse
ligament consists of ligamentous bands, which pass across the notch in the
border of the acetabulum, some pass from the pubis to the ischium, others
decussate these and pass from ischium to pubis; it completes the margin of the
cavity and leaves sufficient space above it for the passage of vessels and
nerves.
Inter-articular
ligament, or ligamentum teres, is about an inch and a half in length [38.1 mm.],
it consists of fine ligamentous fibres covered rather loosely by synovial
membrane; though called round, it is rather of a triangular form, the base
attached to the notch and to the depression in the acetabulum, the apex to the
head of the femur; it arises by two flat bands, the superior of which is the
smaller, from the margins of the cotyloid notch, these soon unite being
enveloped by the synovial membrane, the ligament then runs upwards, backwards
and outwards, contracting in size, between the articular fatty mass and the
head of the bone, into the depression on which it is inserted.
[This
ligament is frequently described incorrectly. By one extremity it is attached
to the depression on the head of the femur, towards the other it divides into
two roots; of which one may be traced around the lower edge of the cotyloid
notch, until it is finally lost upon the face of the ischium, between its
tuberosity and the edge of the acetabulum; the other root may be traced to the
upper end of the notch, where it is lost near the edge of the acetabulum; hence
this ligament is not necessarily torn off in the dislocation of the femur, into
the obturator foramen, for in this displacement the two extremities of the
ligament are approximated.]
This
ligament is very rarely wanting, it serves to conduct blood-vessels from the
acetabulum to the head and neck of the femur, which from its position in
respect to the shaft of the bone, may require a nutritious supply from this
source; some consider it may also limit too much abduction of the thigh. This
joint enjoys free motion in every direction, flexion, extension, abduction,
adduction, rotation and circumduction; the depth of the acetabulum, the
strength of its capsular ligament, together with the surrounding muscles, all
seem well adapted to prevent luxation, such accidents, however, not
unfrequently occur.
This joint
is not so liable to dislocation as that of the shoulder for several reasons; in
the first place, its motions are much more limited both in number and extent;
second, the glenoid cavity affords little mechanical security, while the
cotyloid on the contrary permits the head of the femur to sink into it; third,
the oblique direction also of the head of the thigh bone presents an additional
obstacle; fourth, the capsular ligament of this joint is much stronger and
shorter than that of the shoulder, and it is further protected by very strong
accessory fibres on the outer and upper part, which descend from the inferior
anterior spine of the ilium, and by some on the inner side from the superior
part of the foramen ovale.
The joint
of the hip may be dislocated in four ways, backwards and upwards on the dorsum
of the ilium, backwards on the ischiatic notch, forwards and upwards on the
pubes, and forwards and downwards on the foramen obturatorium.
[One case
has occurred of a dislocation of the femur into the perineum; this was probably
a secondary displacement, supervening upon a primary dislocation into the
obturator foramen. This case has never been published, but the minutes of it,
are in the possession of Dr. Parker, Prof. of Surgery in the college.]
The
situation of the trochanter major is a point of great importance in
discriminating accidents about the hip joint, and its relation to some other
prominent points should be well kept in mind; in the erect position of the
body, the superior part of the trochanter major is nearly on the same level with
the body of the pubes, the distance between the anterior superior spine of the
ilium and the trochanter major is less than from this projection to the os
pubis, or from the os pubis to the anterior superior spine, lines connecting
these three points will form nearly a right angled triangie, angle, of which
the longest side is the line connecting the superior spine to the pubis, and
the shortest, that which joins the spine to the trochanter. In dislocation
upwards or backwards the trochanter is brought nearer the superior anterior
spine of the ilium, but is much less prominent than natural: in the luxation
backward it is removed from the body of the pubis, and is also less prominent
than natural in the dislocation into the obturator foramen, the distance between
the trochanter major and the body of the pubis is lessened, while that between
this process and the anterior superior spine is greater than usual.
In
dislocation upwards and backwards, which is by far the most frequent, the head
of the bone rests on the dorsum of the ilium, the upper part of the capsular
ligament is ruptured, and the accessory and round ligamen ligaments are torn:
the limb is shortened about two inches, and is inverted and almost fixed. In
rotation inwards the head of the femur is pressed against the back part of the
capsular ligament, and if the rotation be carried far, a considerable portion
of the bone is outside the cotyloid cavity: hence the species of dislocation
now described is most likely to occur when rotation inwards is accompanied by
external violence, that is by the individual falling or receiving a blow when
the knee and foot are turned inwards. When this dislocation has occurred the
three glutæi muscles are those principally concerned in keeping the head of the
bone fixed on the dorsum of the ilium; but when the limb has been extended and
the head of the bone is sufficiently raised to pass over the edge of the
acetabulum, the psoas and iliacus with the obturator externus and pectinalis,
will assist to bring it into the proper situation. Although in common cases of
dislocation we may presume, from the rapid recovery of the patient, that no
other injury is done to the joint than what has been already described, yet the
dissection of a case of luxation upwards and backwards has been published, in
which the gemelli, pyriformis, obturators, and quadratus femoris, were
completely torn across, with laceration of some fibres of the pectinalis
In the
dislocation backwards, and which is also a little upwards, or that into the
ischiatic notch, the head of the bone rests on the pyriformis muscle and
between it and the sciatic ligaments, the limb is a little shortened, it is
also inverted, but much less so than in the dislocation on the dorsum of the
ilium. This dislocation also is most likely to happen when the thigh is rotated
inwards and bent towards the abdomen.
When the
femur is dislocated forwards on the obturator foramen, the capsular ligament
and the internal accessory fibres are lacerated. The ligamentum teres is,
according to Sir A. Cooper, always ruptured: the limb is lengthened about two
inches, the knee advanced and abducted with slight eversion, the great
trochanter is much less prominent than usual.
In
dislocation upwards and forwards the head of the bone rests on the ramus of the
pubis under Poupart's ligament, where it may be plainly felt; the limb is shortened,
slightly flexed, and everted.
A calculation has been made, that out of twenty dislocations of the hip joint, twelve will take place on the dorsum ilii, five on the ischiatic notch, two on the foramen ovale, and one on the pubis.
Harrison R. The Dublin Dissector, Or Manual of Anatomy: Comprising a Description of the Bones, Muscles, Vessels, Nerves, and Viscera; Also the Relative Anatomy of the Different Regions of the Human Body, Together with the Elements of Pathology. New York: J. & HG Langley, 1840. books.google
Robert Harrison (1796-1858) He was appointed Demonstrator of Anatomy in the College School in 1817 and Professor of Anatomy and Physiology on August 4th, 1827. He became Professor of Anatomy and Chirurgery in the School of Physic at Trinity College, Dublin, in 1887. livesonline.rcseng.ac.uk , collections.nlm.nih.gov
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, properties, role, pathology, dislocation
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