780 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



Circumduclion combining die four preceding 

 is a compound movement, in which the inferior 

 extremity describes a cone, the apex of which 

 is at the joint ; the head of the femur in the 

 course of this motion successively assumes the 

 several situations already described. 



In rotation outwards the head of the femur 

 is directed forwards and inwards, the anterior 

 surface of the neck looks outwards, the pos- 

 terior inwards resting on the brim of the ace- 

 tabulum ; the capsular ligament is put upon 

 the stretch on its inner side. Any sudden jerk 

 or violence when in this position is liable to 

 produce dislocation upwards upon the pubis. 



In rotation inwards the bone assumes the 

 contrary direction, and the capsular ligament 

 and ligamentum teres are equally put upon the 

 stretch. In this case dislocation may occur 

 either upon the dorsum of the ilium or into the 

 sciatic notch. For this motion we have but few 

 muscles, this position being produced merely 

 by the tensor vagina; femoris and anterior fibres 

 of the gluteus medius muscles. The disparity 

 between the number of muscles influencing the 

 motions of rotation outwards and inwards is 

 very striking, but this may be attributed to the 

 direction of the acetabulum from within out- 

 wards and forwards naturally tending to pro- 

 duce rotation inwards. Consequently before 

 the opposite motion can be effected there is 

 this inequality to be overcome, and hence the 

 disparity between the muscles. 



(H. Hancock.) 



HIP-JOINT, ABNORMAL CONDI- 

 TIONS OF THE In this article we shall 

 adopt an arrangement similar to that which we 

 have followed in our former observations on the 

 abnormal conditions of particular joints, and 

 consider these states under the heads of, 1. 

 congenital malformations; 2. the effects of 

 disease, and, 3. the results of accident. 



SECTION I. Congenital malformation of the 

 /tip-joint. The peculiar affection termed by the 

 continental surgeons congenital or "original lux- 

 ation " of the hip-joint, has not in our islands at- 

 tracted the notice that it seems to us to merit. 

 When we reflect upon the very valuable addi- 

 tions which have been made to our knowledge of 

 the pathology of the articulations by British 

 writers, and observe their silence upon this ab- 

 normal state of the hip-joint, we might be led 

 to infer that this malformation had no existence 

 in these islands; this, however, unfortunately is 

 not true. 



In the very valuable museums in London we 

 can easily recognise many unquestionable spe- 

 cimens of this congenital malformation of the 

 bones of the hip-joint. In Dublin we know 

 some living examples of it, and our museums 

 contain preparations shewing some of its va- 

 rieties and most of its usual anatomical charac- 

 ters. 



At the meeting of the British Association in 

 Dublin in the year 1835, Dr. Hutton made 

 some interesting observations on this affection 

 to the section of medical science, and gave an 

 account of a well-marked example of it affect- 

 ing one hip-joint. On that occasion Dr. 



Handyside observed that he had met with a 

 case of congenital luxation of both hip-joints, 

 in a subject which had been brought into his 

 anatomical rooms at Edinburgh ; and he added 

 that the appearances of the joints corresponded 

 very closely with those noticed by Dr. Hutton. 

 The Professor of Anatomy and Surgery to the 

 University of Dublin, Dr. Harrison, laid before 

 the Surgical Society last winter the results of 

 two accurate post-mortem examinations which 

 he had made of this malformation of the hip- 

 joint. The history of these cases, as far as Dr. 

 Harrison could make it out, shewed that the 

 subjects of them had during life presented the 

 ordinary signs of the infirmity in question. 

 In one of them, one hip-joint only was af- 

 fected ; in the second, not only was the arrest 

 of development such as to leave the acetabu- 

 lum a plane surface by depriving it of border 

 of any kind, but the ligamentum teres, the 

 head and greater part of the cervix femoris 

 were also deficient on both sides, so that the 

 femora at their upper extremity presented a 

 rude resemblance to the ossa humeri. In this 

 case (Jig. 307) the capsular ligament was of an 

 extraordinary length, and permitted the rudi- 

 ment of a head and neck, with the trochanter 

 major, to ascend and descend on each side on 

 the dorsum ilii, and to pass backwards on the 

 ischium to the very edge of the ischiatic notch, 

 in the different movements of the patient. 



The case of congenital malformation of the 

 hip-joint has not escaped the notice of conti- 

 nental surgeons,* although perhaps the nature of 

 the affection had not fully attracted the attention 

 of the profession until Dupuytrenf gave the 

 results of his observations of twenty-six cases of 

 this malformation which were presented to him 

 in the course of his public and private practice. 

 He seems to have met with the affection more 

 frequently in the female than in the male, in 

 the vast proportion of twenty-two females to 

 four males, and from his description it would 

 appear that he has usually found, in the same 

 individual, both hip-joints affected. In the 

 cases we hav witnessed, we have not observed 

 this very great preponderance of female over 

 male cases ; and although we have noticed the 

 defect to be double in the same individual, we 

 have more frequently observed but one joint 

 engaged. This is of importance to be recol- 

 lected, as mistakes in our diagnosis are more 

 likely to occur when only one joint is affected, 

 than in those cases in which the defect is 

 double in the same individual. 



The characters, says Dupuytren, of this 

 " original luxation" are nearly similar to all 

 those we notice belonging to the ordinary luxa- 

 tion upwards and backwards on the dorsum 

 of the ilium : the limbs are shortened and inver- 

 ted ; the superior extremities of the femora are 

 carried upwards, backwards, and outwards, iuiu 

 the external iliac fossa, where a considerable 

 prominence can be seen, caused by the unusual 

 elevation of the great trochanter; the thighs, 

 unusually slender, are obliquely directed dovvn- 



v PallrtU, Lafond. Callard, Bcllomrir. 

 t Repertoire U'Anatomic, Lcjous Oialcs. 



