REGION OF THE HIP. 



55 



(iliotrochanteric line of Farabeuf). It marks roughly the posterior edge of the gluteus 

 medius muscle and goes through the upper edge of the gluteus maximus. The gluteal 

 artery and superior gluteal nerves cross this line at the junction of the upper and 

 middle thirds, this being about opposite the posterior inferior spine. A line joining 

 the tuberosity of the ischium and tip of the greater trochanter may be called the 

 ischiotrochanteric line : it is crossed at the junction of its inner and middle thirds by 

 the sciatic nerve. 



The greater trochanter is marked by an eminence in thin people and a depres- 

 sion in the plump and fat. Its anterior upper edge is crossed by the tendon of the 

 gluteus medius and cannot be readily outlined. Its upper posterior extremity or tip 

 is readily distinguished and is the spot used fdr measurements. This point is called 

 the tip of the greater trochanter and must be searched for posteriorly. It is opposite 

 the centre of the head of the femur and is on a 

 level with the spine of the pubis. 



The Roser-Nelaton line is one drawn from 

 the anterior superior spine to the tuberosity of 

 the ischium. It passes through the tip of the 

 greater trochanter. It is of importance in frac- 

 tures and dislocations (Fig. 507). 



Bryant ' s triangle ( ' ' Bryant' s Surgery ' ' , 

 vol. ii, p. 412) is to be drawn while the patient is 

 lying on his back. One side is a perpendicular 

 let fall from the anterior superior spine to the 

 table, the other side is one joining the anterior 

 superior spine and the tip of the greater tro- 

 chanter, the base is a line running horizontally 

 from the tip of the greater trochanter to the 

 perpendicular line (Fig. 507). If the tip of the 

 trochanter becomes elevated, as in fractures of 

 the neck of the femur, it shortens the base of 

 the triangle on the affected side as compared 

 with the base of the triangle on the sound side. 



The anterior iliotrochanteric line may be 

 designated as a line joining the anterior supe- 

 rior spine and the tip of the greater trochanter. 

 In normal individuals it slopes downward and 

 backward, forming an iliotrochanteric angle 

 (b a c, Fig. 507) of about 30 degrees. In 

 cases of fracture or luxation this angle becomes 

 reduced as the shortening increases until the 

 tip reaches the level of the anterior superior spine. A rough estimate of this angle 

 by sight and palpation usually enables one to decide immediately as to the presence 

 of shortening from fracture or luxation without the trouble of erecting Bryant's 

 triangle. The anterior iliotrochanteric line forms the anterior side of Bryant's triangle 

 and the anterior half of the Roser-Nelaton line. 



The gluteal cleft separates the buttocks. In its lower portion can be felt the 

 coccyx. The gluteal (glutcofemoral^ fold is formed mainly by the subcutaneous 

 fatty tissues and passes horizontally outward from the lower part of the gluteal cleft. 

 A shortening of the leg on either side causes the corresponding fold to incline down- 

 ward. It is marked in extension and gradually lessens on flexion and disappears 

 when 90 degrees is reached. It is crossed obliquely downward and outward at about 

 its middle by the lower edge of the gluteus maximus. Its disappearance in coxalgia 

 is caused by the flexion incident to that affection. 



Ligation of the Gluteal, Sciatic, and Internal Pudic Arteries. To 

 ligate the gluteal artery incise the skin and part the fibres of the gluteus maximus in 

 the upper two-thirds of a line joining the posterior superior spine and the top of the 

 great trochanter (Fig. 508). Pull the lower edge of the gluteus medius up and the 

 artery and superior gluteal nerve will be seen coming out between it and the pyri- 

 formis. To ligate the sciatic and internal pudic arteries an incision parallel to the one 



FIG. 507. View of the outer surface of the 

 bones of the hip showing Roser-Nelaton line 

 (a-d), Bryant's triangle (a be), iliotrochanteric 

 line, (a c) and the iliotrochanteric angle (bac). 



