ABNORMAL CONDITIONS OF THE HIP-JOINT. 



821 



cannot be rotated inwards, nor flexed with- 

 out causing acute suffering. The inguinal 

 region is the scat of the principal pains, which 

 howerer from this point extend along the thigh, 

 and are the consequence of the stretching which 

 the anterior crural nerve necessarily suffers as 

 it is raised up at the neck of the bone. 



The striking criterion of this dislocation is, 

 that the head of the thigh-bone may be dis- 

 tinctly felt upon the pubes, above the level of 

 1'oupart's li'.'umunt, and it feels as a hard ball, 

 which is readily perceived to move by bending 

 the thigh-bone. The femoral artery has been 

 usually felt pulsating along the inner side of 

 the head of the bone, but Mr. Smith presented 

 lately to the Pathological Society the cast of 

 a case of this luxation, in which he had noticed 

 that the femoral artery ran in a tortuous 

 manner directly across the head of the dislo- 

 cated bone. 



The great trochanter is drawn upwards and 

 forwards, so as to be situated in the tmjet of a 

 line which would pass from the anterior infe- 

 rior spine of the ilium, downwards and for- 

 wards. In a case of a dislocation of this spe- 

 cies which was left a long time unreduced, the 

 motion of the knee backwards and forwards 

 was fully twelve inches. The following case 

 was admitted into Jervis Street Hospital, under 

 the care of Mr. O'Reilly, during the time I 

 was one of the surgeons to that institution, and 

 as it seemed to me the best marked case of the 

 kind I had ever witnessed, I beg here to lay it 

 before the reader from my case-book. 



Caw. P. Bryan, a powerful man, aged 37, 

 was admitted into Jervis Street Infirmary, 

 Dec. 4, 1828. He was intoxicated when the 

 accident which produced the luxation occurred, 

 and consequently was unable to give any idea 

 as to how the injury was produced. 



As the patient lay on his back in bed the 

 affected limb appeared to lie parallel to its 

 fellow, but then there was an eversion of the 

 whole limb, and the foot of course turned out- 

 wards. One circumstance particularly caught 

 our observation, viz. the preternaturally arched 

 appearance which the upper third of the shaft 

 of the femur presented ; the adductor muscles 

 wei-e full and prominent; there was an unusual 

 prominence underneath I'oupart's ligament; 

 the. anterior superior spinous process appeared 

 retired. 



On making more minute examination it was 

 found that the eversion of the foot was perma- 

 nent, and we were surprised to find that there 

 was but little difference between the length of 

 both limbs; certainly the injured one was little 

 more than half-an-inch shorter than the sound 

 one. A considerable depression existed where 

 formerly the trochanter major lay ; this process 

 of bone was very evident, and could be readily 

 felt about two inches below and somewhat 

 anterior to the anterior superior spinous pro- 

 <i >s of the ilium, and about the same distance 

 internal to it a well-marked prominence in the 

 inguinal region shewed the new situation which 

 the head of the femur occupied ; almm its 

 inner side were seen and felt the pulsations of 



the femoral artery. On communicating a 

 motion of rotation outwards, the head of the 

 bone could be easily felt under the soft parts ; 

 the nates was flattened ; the femur was but 

 little moveable with respect to the pelvis, and 

 any attempt to draw the thigh backwards 

 caused great pain to the patient : to flex it was 

 impossible. A motion of rotation outwards 

 could be communicated to the dislocated femur, 

 but no rotation inwards was permitted. Ad- 

 duction of the limb was admissible, even to 

 permit the knees to touch. When the patient 

 stood up, he naturally threw his weight on the 

 sound limb, and the affected one was flexed 

 slightly at the knee, and the heel touched the 

 inside of the opposite foot, as in the " first 

 position" of dancers. The reduction of the 

 dislocation was effected in the ordinary method ; 

 indeed the rules laid down by Sir. A. Cooper 

 were fully adopted, and in due time succeeded. 

 Anatomical character* of this luxation. 

 Sir. A. Cooper gives us an account of the dis- 

 section he made of one of these luxations of the 

 femur on the pubes, which had been a long 

 time unreduced; he found the original ace- 

 tabulum partially filled by bone, and in part 

 occupied hy the trochanter major, and both are 

 much altered in form ; the capsular ligament is 

 extensively lacerated, and the ligamentum U res 

 broken. The head of the thigh-bone had torn 

 up I'oupart's ligament, so as to be admitted 

 between it and the pubes (fig. 325). The head 



Fig. 325. 



Ltumliim on the pake*.* 



and neck of the bone were thrown into a position 

 under the iliacns interims and psoas muscles, 

 tin- tendons of which, in passing to their in- 

 sertion over the neck of the bone, were elevated 

 by it and put on the stretch. The crural nerve 

 passed on the fore-part of the neck of the bone, 



* From Sir .1. Cooper, loc. cit. plalc v. 



