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ABNORMAL CONDITIONS OF THE HIP-JOINT. 



however, the weight of the body is almost 

 entirely thrown on the unaffected limb, the 

 latter becomes much larger and stronger than 

 usual, while the malformed limb falls into a 

 state of more or less of atrophy from want of 

 use; its circulation in general seems more 

 languid, and its nervous energies and tempera- 

 ture are less than those of the well-formed ex- 

 tremity ; add to this, as we have already noticed 

 (what might be expected,) that in consequence 

 of the centre of gravity being so uniformly 

 thrown on the sound limb, a lateral curvature 

 of the spine takes place, and a great mobility 

 of the sacro-lumbar articulation exists. 



Anatomical characters of this affection. 

 Opportunities for ascertaining the anatomy of 

 this congenital defect, whether both hip-joints 

 be implicated or one only affected, are very 

 rare. Although Dupuytren has seen so many 

 patients afflicted with this malformation, he has 

 had very few opportunities, he says, of study- 

 ing its anatomy, because the affection is not a 

 disease, but an infirmity which has no tendency 

 to shorten life. With respect to the muscles he 

 has remarked, that some of them around the 

 joint are found to be well developed, while 

 others are in a state of atrophy : the first are 

 those which have still preserved their functions, 

 the second are those whose action has been 

 restrained by changes induced in the position 

 and form of 'the parts : some of these latter, he 

 says, are reduced to a sort of yellow fibrous 

 tissue, in which we can scarcely discover mus- 

 cular fibre. 



The cotyloid cavity of the os ilii in some 

 cases scarcely can be said to exist, so irregular 

 are the traces of it; sometimes an irregular 

 bony eminence occupies its place, having no 

 cartilaginous covering, no rudiment of cotyloid 

 ligament ; it is merely surrounded by resistant 

 cellular tissue, and covered by muscles which 

 pass by it to be inserted into the little tro- 

 chanter. Sometimes, says Dupuytren, I have 

 found the ligamentum teres of the articulation 

 much elongated, flattened superiorly, and worn 

 as it were in certain points by the pressure and 

 friction of the head of the femur ; the latter is 

 lodged in a cavity analogous enough to that 

 which we find formed in cases of luxation up- 

 wards and outwards, which have been left for a 

 long time unreduced. This cavity (if such it 

 can be called) is situated in the external iliac 

 fossa, above and behind the usual situation of 

 the cotyloid cavity, at a height proportioned 

 to the shortening of the limb, or degree of ascent 

 of the head of the femur. The superior portion 

 of the femur preserves in all its parts, its form, 

 its dimensions, and its natural relations, only 

 the internal side, and the anterior part of the 

 head of this bone has sometimes lost its 

 rounded form, a circumstance which would ap- 

 pear to result from the friction which it has been 

 subjected to by its frequent contact with parts 

 which have not been organized to receive it. 



The writer's observation does not entirely 

 correspond with this account of the superior 

 portion of the femur preserving its form and 

 natural relations with the rest of the bone. He 

 has usually noticed that the head of the femur 



has lost its spheroidal shape, and presents 

 somewhat of a conical appearance, as Dupuy- 

 tren well describes ; but two other circumstances 

 he has observed in almost all the cases he has 

 examined, whether in the recent dissections he 

 has himself witnessed, or in the macerated 

 bones he has seen in Dublin or elsewhere : 

 1st, that the neck of the femur, instead of 

 having its axis directed, as it naturally is, from 

 behind forwards, upwards, and inwards, lias in 

 this malformation lost its usual relation with 

 the shaft of the thigh-bone, and the axis is 

 directed upwards, and almost directly forwards. 

 This alteration in the direction of the axis of 

 the neck of the thigh-bone did not escape the 

 observation of Dr. Hutton, in his remarks on 

 his case already alluded to ; he expressed his 

 idea of the altered direction of the axis by say- 

 ing that the axis of the neck in this case fell 

 directly on the anterior part of the upper ex- 

 tremity of the shaft : " the relative position of the 

 neck and shaft appeared as it might be supposed 

 to do if, the lower portion of the femur being 

 fixed, the upper portion were twisted forwards, 

 the head moving through one fourth of a circle." 

 2dly. The other circumstance which the writer 

 has noticed must be viewed in connec- 

 tion with this altered direction of the usual 

 axis of the neck of the femur just alluded to ; 

 it is that in all the cases he has as yet seen of 

 this original luxation of the femur, the head of 

 the thigh-bone, instead of being directed back- 

 wards, as it is in the ordinary luxation on the 

 dorsum ilii, on the contrary has been directed 

 forwards, and has been placed beside the 

 anterior inferior spinous process of the ilium, 

 while the trochanter major has been directed 

 backwards on the dorsum ilii. 



It is rather strange that a relative position of 

 the bones of the hip-joint, so different from 

 what has been observed in the ordinary dis- 

 location upwards on the dorsum ilii, and one 

 so usually met with in the case of original lux- 

 ation of the hip-joint, should have heretofore 

 escaped observation. 



In one of the specimens of malformation of 

 the hip-joint preserved by Mr. Harrison in the 

 Museum of the University of Dublin, this 

 relative position of the femur and the anterior 

 inferior spine of the ilium can be noticed, 

 while the trochanter major is placed posterior 

 to both. And in two preparations preserved 

 in the Richmond Hospital Museum, the same 

 observation can be made, the atrophied heads 

 of the thigh-bones are directed forwards ; the 

 great trochanters lie behind these heads on the 

 sides of the pelvis. 



These are circumstances important for us to 

 keep in mind, when we are considering the 

 diagnosis of the various affections of the hip- 

 joint. 



We say that such a remarkable circumstance 

 demands notice from us, because in the cases of 

 this affection we have as yet observed in the living 

 subject, the thigh, leg, and foot of the malformed 

 limb has not been so much inverted as it 

 always is in the ordinary luxation upwards and 

 backwards on the dorsum ilii; indeed in the 

 case of a lad, named Hannon, whom the writer 



