ABNORMAL CONDITIONS OF THE HIP-JOINT. 



809 



with spots resembling ivory, while the upper 

 surface of the lower fragment was widely ex- 

 panded into a cup. \Ve have, in our museum, 

 a very remarkable specimen of this abnormal 

 condition of the hip-joint. The upper orcoty- 

 loid fragment seems united to the acetabulurn 

 by an imperfect anchylosis, while the lower 

 surface of this fragment represents perfectly the 

 half of a sphere looking downwards ; the neck 

 of the femur has been entirely removed, and a 

 cup is hollowed out in the great trochanter to 

 receive the convex surface of the upper frag- 

 ment above alluded to. This surface, as well 

 as the cavity formed in the trochanter, have the 

 polish and hardness of ivory. The history of 

 the case, as to how the functions of the joint 

 had been performed, is unknown. The patient 

 died in the Richmond Hospital, under the care 

 of Dr. Hutton, of a disease unconnected with 

 the chronic affection of the hip-joint. In the 

 examination of old cases of intra-capsular frac- 

 ture, we have found the capsular ligament short 

 and strong, as already mentioned, and that it 

 retained the trochanters close to the brim of the 

 acetabulum, the cervix femoris having been 

 altogether removed. In a case which Mr. Bra- 

 bazon and the writer examined lately, of an old 

 woman who had fractured the neck of her 

 femur several years before her death, and in 

 whom there was shortening of the extremity for 

 two inches and a half, the neck of the femur 

 had altogether disappeared to its base The 

 surface on the internal part of the shaft of the 

 femur, from which the neck of the bone nomi- 

 nally springs, was plane and smooth, and no 

 vestige even of the lesser trochanter existed. 

 The under surface of the globular-shaped head 

 of the femur was removed to the exact level of 

 the brim of the acetabulum, in which the re- 

 mainder of the head was still retained by an 

 inter-articular ligament, which seemed to have 

 been reduced to the structure of loose cellular 

 membrane. The acetabulum of this side, too, 

 was evidently smaller than that of the opposite 

 side, and the cartilage covering it, and that also 

 investing the remnant of the head of the bone, 

 were partially removed. From want of use, it 

 would appear that all these parts were in a 

 state of atrophy. In this respect there was a 

 correspondence between the internal and exter- 

 nal structures of the broken limb, for the whole 

 extremity was deformed, shortened, and, as is 

 usual, much reduced in size when compared 

 with the opposite limb. Union by means of 

 a ligamento-cartilaginous substance is by no 

 means uncommon. In this case, as in almost 

 all others, the neck of the thigh-bone altogether 

 disappears, and the trochanters are brought up 

 to the level of the acetabulum, which still re- 

 tains the remnant of the head of the bone. The 

 broken surfaces are united closely enough to 

 each other by a fibrous substance, and this 

 union is sufficiently analogous to that which 

 we frequently see in cases of fractured olecra- 

 non or patella. 



We have spoken of a species of fracture 

 which is called the impacted fracture. In this 

 case the femur is broken generally at the basis 

 of the neck, not far from the inter-trochanteric 



lines : sometimes it is only the under part of 

 the neck which is broken, and then the frac- 

 ture is only partial ; but generally the compact 

 tissue all round this portion of the neck is, by 

 an accident, cracked across, and the superior 

 fragment, that is, the whole of the cervix femoris, 

 is impacted into the cellular structure of the 

 superior extremity of the shaft of the femur 

 (Jigs. 319, 320). The limb is shortened half an 

 inch, and in general everted. In the Dublin 

 Hospital Reports, vol. ii. Mr. Colles has given 

 a good delineation of this species of fracture. 

 In Sir A. Cooper's work, also, similar specimens 

 may be seen of this impaction of the upper frag- 

 ment. " La realite de ce fait iuteressant" seemed 

 new to the editors of Dupuytren's " Lecons 

 Orales," in 1832, in which we find it stated that 

 the superior fragment of the broken neck of the 

 thigh-bone is sometimes driven into the thick- 

 ness of the spongy texture of the superior ex- 

 tremity of the inferior fragment, and the conso- 

 lidation is effected readily enough. To con- 

 clude in the words of the Lecons Orales : 

 " plusieurs pieces d'anatomie pathologique, 

 tirees du Museum de FHotel Dieu, et represen- 

 tant les fragmens ainsi consolides, ont etc mon- 

 trees a I'amphitheatre, et ont convaincu chacun 

 de la realite de ce fait interessant. II est utile 

 de noter cette cause de deviation; elle peut 

 rendre compte, suivant les cas, de quelques faits 

 exceptionnels de deviation du pied en dedans 

 dans la fracture du col du femur, faits excep- 

 tionnels, qui ont ete observes par plusieurs 

 auteurs."* In the museum of the Richmond 

 Hospital we have some specimens of this frac- 

 ture. Fig. 319 represents a section of the supe- 



Fig. 319. 



rior extremity of the femur of a woman who 

 met with this species of fracture. The history 

 of her case, as recorded in the catalogue, is as 

 follows : " Mary M'Manus, set. 52. Fracture 

 of the neck of the femur external to the cap- 

 sule. The upper fragment has been driven 

 down, and has become firmly impacted in the 

 cancelli of the shaft of the bone. The trochan- 



* Le?ons Orales, torn. ii. p, 100. 



