802 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



upon the upper surface of its head which 

 supports the acetabulum in standing and pro- 

 gression. The form of the head of the bone 

 becomes changed and flattened from above 

 downwards ; something like a bending or 

 yielding of the neck of the bone may now 

 be observed, and sometimes the inferior part of 

 the circumference of the head of the femur is so 

 much depressed that the under surface of the 

 head has approached to the lesser trochanter. 



Fig. 317. 



Upon a cursory examination, it looks as if the 

 " head of the bone were forced downwards by 

 the action of some great pressure from above, 

 and cases have occurred in which at last the 

 head of the femur seemed to have sunk even 

 below the level of the great trochanter, and to 

 be supported by the lesser." ( B. Bell.) 



But besides these which we attribute to the 

 effects of physical causes, there is, in the con- 

 templation of the morbid results of this chronic 

 disease of the hip-joint, sufficient to satisfy us 

 that a very active vital process is going on in 

 the interior of the bones, as well as in all the 

 structures around the diseased joint. The 

 thickening of the fibrous capsule, and hyper- 

 amic state of the synovial structures, the exu- 

 berant growth of bone which we see around 

 deepening the acetabulum, or surrounding its 

 brim with bony nodules; the enlargement of 

 the head of the femur, so as to make this head 

 assume an oval convex surface, measuring in 

 circumference ten inches and a half, as in the 

 specimen from which the drawing (Jig. 317) was 

 taken, all these are sufficient proofs that besides 

 the interstitial absorption going on in the interior 

 of the cervix femoris in these cases, a very 

 active condition of the minute arteries exists 

 externally, giving birth to those exostotic 

 deposits which encircle the head and inter- 

 trochanteric lines of the femur. It has been 

 remarked, and we think with much truth, that 

 those specimens which have been frequently 

 produced and mistaken for united fracture of 

 the neck of the femur, have been examples of 

 interstitial absorption of the neck of this bone 

 combined with external exostotic deposits; but 

 these mistakes, however, we trust are not here- 

 after likely to occur. 



SECTION III. Accident. The hip-joint is, 

 of course, like the other articulations, liable to 



sprains and to contusions. These do not re- 

 quire any special notice here; but fractures 

 and luxations of the bones of this important 

 articulation demand from us full consideration. 



I. Fractures. Fractures of the os innomi- 

 natum may traverse the bottom or fundus of 

 the acetabulum, or some portion of the brim 

 of this articular cavity may have been broken 

 off. 



1. Fracture oj" the acetabulum . A. Fracture 

 of its fundus. When fracture of the bones of 

 the pelvis happens to traverse the bottom of the 

 acetabulum, the prognosis is unfavourable, as it 

 is in all casesof fracture of the bones of the pelvis. 

 When this fracture through the fundus of the 

 acetabulum is the consequence of a fall on the 

 feet, knees, or trochanter major of the femur, it 

 sometimes happens that the head and neck of 

 the femur unbroken are driven into the 

 cavity of the pelvis. " Nous avons observe," 

 says Dupuytren, " plusieurs ibis, 1'enfonce- 

 ment de la cavite cotyloide par la pression 

 exercee par la tete du femur, a la suite d'une 

 chute sur le pied ou les genoux." In this case, 

 the head of the femur is driven with force 

 against the fundus of the acetabulum, and the 

 hitter breaks, and is crushed in, " enfonce." The 

 most remarkable case observed by Dupuytren 

 was the following : " The bottom of the cotyloid 

 cavity had been driven in, and the head of the 

 femur had passed entirely into the pelvis. The 

 neck, which had not suffered any solution of 

 continuity, was so strongly engaged in the 

 opening, that, even when making the anatomi- 

 cal examination, I found it very difficult to 

 disengage it, and to reduce this new species of 

 luxation."* As these important remarks of 

 Dupuytren are not accompanied by all the 

 detail that is to be desired, where novel obser- 

 vations are reported, we shall here adduce the 

 following case of fracture of the fundus of the 

 acetabulum, with displacement of the head of 

 the femur into the pelvis. Death occurred on 

 the fortieth day after the injury, from diffuse 

 inflammation. An opportunity was afforded to 

 us of investigating anatomically the precise na- 

 ture of the lesions in this case. 



On the 3rd of December, 1834, a man, 

 named William Sherlock, set. 26, a painter by 

 trade, was admitted into Jervis-street Hospital, 

 under the care of the late Mr. Wallace. A 

 few minutes before his admission, this poor 

 man had fallen from a ladder, from a height 

 reported to be fifty feet, on the flags of the 

 street. On the next day, the 4th of December, 

 when he had recovered from the insensibility 

 and collapse which had succeeded to the fall, 

 we found him complaining of intense pain of 

 the right hip. He was quite unable to move 

 the right thigh, and would not permit any exa- 

 mination of the hip, as the slightest movement 

 communicated to the limb produced intense 

 agony. The integuments covering the tro- 

 chanter were discoloured, and there was much 

 swelling around the hip-joint. The right or 

 injured extremity was two inches shorter than 

 the left, which circumstance he attributed to a 



* Lecons Orales. 



