THE HIP-JOINT. 367 



The greater trochanter is almost subcutaneous, being covered by the aponeu- 

 rotic insertion of the upper fibres of the gluteus niaximus. It is from 7.5 to 10 cen- 

 timetres (three to four inches) below the crest of the ilium. In the erect position 

 it is slightly anterior to and farther from the mid-line than the mid-point of the 

 crest. It is visible in thin persons, and assumes abnormal prominence when there 

 has been wasting of the gluteal muscles, as the gluteus medius and minimus nor- 

 mally efface the hollows between it and the ilium. In fat or muscular persons 

 the fascial attachments to the trochanter cause a visible depression. Its upper 

 border is on a level with the centre of the acetabulum (so that Nelaton's line passes 

 over those two points}, is nineteen millimetres (three-quarters of an inch) lower 

 than the top of the femoral head, and is almost on a level with the pubes. The 

 depression immediately beneath it corresponds to the tendinous lower portion of 

 the gluteus maximus close to its insertion. The gap between it and the iliac crest 

 is bridged over by the upper portion of that part of the fascia, lata known as the 

 ilio-tibial band. Relaxation of this band in fracture of the femoral neck can be both 

 felt and seen (Allis). 



The three gluteal bursae interposed between the trochanter and the gluteal 

 muscles may become enlarged, especially that beneath the gluteus maximus, and 

 obscure the outlines of the trochanter. This condition is sometimes mistaken for 

 hip-joint disease, as the thigh is usually adducted and flexed on the pelvis, because 

 abduction and extension bring into action the gluteal muscles, and thus cause painful 

 pressure on the bursa. Inflammation of that bursa is almost always the result of 

 a blow upon the trochanter ; the joint movements are free, there is no referred pain 

 in the knee, and forcing the head of the femur against the acetabulum by pressure 

 upon the knee is painless, as is pressure over the capsule of the joint below Pou- 

 part's ligament. 



In subcutaneous osteotomy of the neck of the femur the incision for admission 

 of the saw is made about one inch in front and one inch above the top of the 

 trochanter. The saw cut runs parallel with Poupart's ligament and is about 2.5 

 centimetres (one inch) below it. 



The l.esser trochanter cannot be felt. 



The shaft of the femur is deeply situated and cannot be closely approached 

 for palpation, except at the outer side of the lower third in the space between the 

 biceps and vastus externus. 



The most prominent part of the inner rounded surface of the knee is the 

 tuberosity on the inner condyle of the femur. Above it is the adductor tubercle 

 marking the tendinous insertion of the great adductor and just above the inner end 

 of the epiphyseal line. 



The external condvle is subcutaneous. 



The remaining landmarks in this region will be considered in relation to the 

 knee-joint and the soft parts (page 671). 



THE HIP-JOINT. 



This is a ball-and-socket joint. The socket is formed by the acetabulum with 

 the assistance of the transverse and cotyloid ligaments. The articular facet which 

 bears the articular cartilage has been described. The notch at the lower part of the 

 periphery of the acetabulum is bridged over by the transverse ligament' ( Fig- 

 384), a collection of interlacing fibres, which thus completes the margin of the socket. 

 An opening is left below it through which vessels and nerves pass ; from its sides 

 the round ligament" arises Some fibres of the transverse ligament mingle with 

 those of the latter. The cotyloid ligament^ (Fig- 384) is a fibro-cartilaginous rim, 

 which deepens the socket overlapping the head of the femur until the cavity embraces 

 more than half a sphere. It is attached to the edge of the acetabulum, and, where 

 this is wanting, to the transverse ligament. The cotyloid ligament is about five 

 millimetres broad at the attached base, and narrows to a sharp border, so as to be 

 triangular on section. The distance from the base to the free edge is very nearly 

 one centimetre at the top of the joint, where it is greatest. The non-articular space 

 at the bottom of the joint is filled with fat and by the round ligament nearly up to 



' Lig. transversum acetabuli. - Lig. teres femoris. ^Labrum glenoidale. 



