814 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



ten months, during which time he was con- 

 tented to remain most of the time in his bed, 

 but when placed on his feet, could stand very 

 well, and was able but unwilling to walk. On 

 Tuesday the 20th of May he got an attack of 

 bronchitis, which, the following Friday, ter- 

 minated fatally. At twelve o'clock, on Satur- 

 day, the 25th May, assisted by Mr. Brabazon 

 and some of the pupils of the hospital, I made 

 an examination of the body. The right leg and 

 thigh were much everted. The trochanter 

 major was elevated, and projected much out- 

 wards ; the degree of shortening just amounted 

 to one inch ; the muscles presented a healthy 

 appearance, the capsular ligament was of a yel- 

 lowish colour, and somewhat thickened. The 

 femur was removed from the acetabulum ; this 

 latter cavity presented a healthy appearance, ex- 

 cept towards the margin of it; here the cartilage 

 was softened. The round ligament was sound. 

 The head and neck of the bone had lost their 

 normal obliquity, and were directed nearly ho- 

 rizontally inwards (fig. 311); the cervix pre- 

 sented, both anteriorly and posteriorly, evidence 

 of a transverse intra-capsular fracture having oc- 

 curred ; the globular-shaped head was closely 

 approximated behind and below to the posterior 

 intertrochanteric line, and to the lesser trochan- 

 ter, so that the neck seemed altogether lost 

 except anteriorly, where a very well-marked 

 ridge of bone shewed the seat of the displace- 

 ment and of the union of the fragments. 

 Fig. 321. 



Fig. 322. 



This ridge is evidently the upper extremity of 

 the lower fragment of the cervix. The fracture 

 of the neck posteriorly was found to have been 

 closer to the corona of the head than anteriorly, 

 and the ribro-synovial fold in the former situa- 

 tion remained unbroken. A section has been 

 made of the bone through the head, neck, and 

 trochanter ; one portion has been subjected to 

 maceration and to boiling ; and the bony union 

 has been unaffected by these tests. Scarcely 

 any portion of the neck can be said to have 

 been left. 



The section, fig. 322, shews the compact line 

 which denotes the union of the fragments ; the 

 head and shaft seem to be mutually impacted 

 into each other, and almost the whole of the 

 cervix has been absorbed ; the line of union is 

 serrated, solid, and immoveable; and the cells of 

 the head and substance of the shaft seem to 

 communicate freely in all places, except where 

 the thin line of compact tissue here and there 

 points out the seat of the welding together of 

 the remaining portions of the head and neck of 

 the femur. 



The bone was in its recent state, on the 25th 

 of May, laid before a meeting of the Patho- 

 logical Society. It seemed to be the univer- 

 sal opinion of the members present that it 

 was a decided specimen of the intra-capsu- 

 lar fracture of the cervix femoris, which had 

 been solidly united by bony callus. This case 

 may be adduced in formal contradiction to 

 the observation and theories of that very emi- 

 nent pathologist, Cruveilhier. It cannot be 

 said to invalidate the more guarded opinions 

 of Sir A. Cooper, who, in his observations upon 

 this subject, distinctly stated that "he would 

 not be understood to deny the possibility of 

 union, when the bone was broken, without its 

 periosteum and reflected ligament being torn, 

 or when there was no separation of its fractured 

 ends." 



Cases such as the foregoing are certainly 

 rare, but they appear to the writer to belong to 

 the class of impacted fractures; they differ from 

 those alluded to in the foregoing article merely 

 in this, that in the former the fracture of the 

 cervix takes place at its basis near the trochan- 

 ters, and that, in the latter, the fracture occurs 

 near to the head of the bone, and is thus en- 

 tirely intra-capsular, or rather may be considered 

 as fractures of the intra-capsular portion of the 

 cervix femoris. The question then, viz. does 

 bony consolidation of the intra-capsular frac- 

 ture of the cervix femoris ever occur? seems 

 to us replied to in the affirmative. 



When an impaction of one, or a mutual 



