6oo A MANUAL OF ANATOMY 



branches, as follows : one to the hip-joint, one to the pectineus, and one to 

 reinforce the anterior division of the normal obturator nerve. 



The obturator externus is next to be cut and reflected, in order to expose 

 the obturator membrane and obturator artery. The artery should be 

 shown to divide into an internal and external branch (the latter furnish- 

 ing an articular branch to the hip-joint), and the arterial loop formed 

 by these two branches at the circumference of the obturator membrane 

 should be made out. The anastomosis in the obturator externus between 

 the obturator and internal circumflex arteries will now be readily under- 

 stood. The adductor magnus is next to be fully studied. Its division 

 into three parts is to be shown, as well as the four tendinous arches under 

 which the four perforating arteries pass. The relation of the muscle to 

 Hunter's canal is to be noted, and the femoral opening for the passage of the 

 superficial femoral artery and corresponding vein is to be dissected. The 

 dissector should now replace the adductor brevis, adductor longus, and pec- 

 tineus, and the relative positions of these muscles should receive attention. 

 The anterior portions of the gluteus medius and gluteus minimus should be 

 cleaned by removing the fascia lata, and when they are reflected the bursae 

 between them and the great trochanter should be shown, as well as the 

 strong arched band of fibres which connects the tendon of the gluteus minimus 

 with the upper part of the capsule of the hip-joint. 



Hip-Joint. — A careful study of the hip-joint should now be made, pre- 

 paratory to the removal of the limb, and this should be done in the following 

 order: (i) The muscular relations of the capsular ligament should be care- 

 fully noted, the muscles not yet cut should be divided, the bursa beneath the 

 ilio-psoas should be observed, and the two heads of the rectus femoris should 

 be again studied. The actions of the various muscles upon the joint should 

 also be studied. (2) The capsular ligament should be cleaned, and an occa- 

 sional opening in it should be looked for underneath the ilio-psoas bursa. 

 The various accessory bands should be attended to, and their influence over 

 the movements of the joint should be observed. The attachments of the 

 capsule to the femur in front and behind are to be noted, and the difference 

 in direction of the anterior and posterior fibre*?, as well as their relative strength, 

 observed. The effect of different positions of the Umb upon the head of the 

 femur should be attended to. (3) The capsular Ugament should be divided, 

 and the ligaments within the joint studied, namely, (a) the cotyloid ligament, 

 (b) the transverse ligament, and (c) the ligamentum teres. The synovial or 

 Haversian gland is also to be noted. As regards the ligamentum teres, a 

 good plan to adopt is as follows : the dissector of one limb should examine 

 the hip-joint in the usual manner, namely, from the front, and the dissector 

 of the other Umb should avail himself of this examination. The dissector 

 of the other Umb should saw through the upper part of the shaft of the femur, 

 and leave the hip-joint undisturbed in the meantime. Subsequently, when 

 the pelvis has been sufficiently dissected, the dissectors of the abdomen, in 

 conjunction with the dissectors of the lower limbs, should open into the 

 hip-joint on the side on which it has been left undisturbed by operating upon 

 the smooth incUned pelvic aspect of the ischial portion of the hip-bone. This 

 dissection wiU enable the dissectors to study the action of the ligamentum 

 teres with the capsular Ugament left undisturbed. (4) The synovial membrane 

 of the joint is to be studied. (5) The bony articular surfaces are to be 

 examined. (6) The movements at the joint, and the muscles by which 

 these are effected, are to be thoroughly mastered, and the arterial supply aiid 

 nerve-supply are to be reviewed. 



The relations of structures to the anterior intertrochanteric Une should 

 next receive attention, and the obturator canal and its contents should be 

 examined. The relative position of the muscles from the symphysis pubis 

 outwards to the obturator foramen should be noted. Finally, the relative 

 positions of the tendons of insertion of the sartorius, gracilis, and semi- 

 tendinosus, and the bursa in connection with them, should be examined. 



The dissector is now prepared to remove the limb. Any muscles passing 

 between the pelvis and the thigh are to be cut, and the ligamentum teres is 



