810 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



ter minor is split, the fissure passing at right 

 angles with the body of the femur. The de- 

 scending ramus of the pubis was broken ob- 

 liquely, the fracture passing downwards and 

 inwards from the thyroid foramen. There was 

 a large effusion of blood into the crushed can- 

 celli of the bone. The patient, from whom the 

 preparation 'was taken, was thrown down by a 

 cart loaded with hay. The horse and cart 

 passed over her. The injured limb was short- 

 ened three quarters of an inch, the foot was 

 everted, and the slightest motion was painful. 

 She died on the fourth day after the occurrence 

 of the accident, having never recovered from 

 the shock." Another specimen (fig. 320) shews 



Fig. 320. 



this species of fracture in the case of a woman 

 who survived the accident. " Alicia Sherlock, 

 set. 64. Section of the head and neck of the 

 femur, shewing fracture of the cervix external 

 to the capsule. The neck of the bone has sunk 

 nearly to a right angle with the shaft. The 

 compact structure which lines the concavity of 

 the cervix has been broken, while the very 

 thin stratum which invests the upper surface 

 has yielded to the force without breaking, but 

 the cervix has sunk into the cancellated texture 

 of the shaft at a right angle, and is now sup- 

 ported upon the lesser trochanter. There is no 

 motion whatever between the broken surfaces, 

 nor the slightest trace of fracture at the central 

 part of the neck of the bone. The injury was 

 produced by a fall on the trochanter. There 

 was but little alteration in the position of the 

 foot, but the tendency was to eversion. The 

 shortening amounted to half an inch, and cre- 

 pitus was not distinguishable. The patient 

 lived three months and a half after the receipt 

 of the injury." In both these cases we have a 

 confirmation of our opinion, that the reduction 

 of the compact arch of bone which occupies 

 the under surface of the neck of the femur to a 

 thin lamina, predisposes to fracture of this por- 

 tion of the neck of the thigh-bone. In the case 

 in which the examination was made four davs 

 after the accident (fig. 319) we find, of course, 



that there was no osseous deposition around 

 the inter-trochanteric lines, but that, on the 

 contrary, in the case, A. Sherlock, (fig. 320), 

 which survived the accident for more than three 

 months, exuberant growths of bone surrounded 

 the seat of fracture, and contributed to form a 

 kind of socket, which received the superior 

 fragment, by means of which the patient was 

 enabled to throw her weight on the injured 

 limb, and even to walk. The lesser trochanter, 

 in most of the cases which we have examined, 

 was greatly increased by bony depositions, and 

 became a prop to support the head, and it is 

 probable that, in these cases, the acetabulum is 

 propped up by the growths of bone from the 

 shaft of the femur. " This is a mode of union," 

 says Mr. Colles, (alluding to the impaction,) 

 u very little inferior to callus in point of firm- 

 ness, but very different in its nature," and 

 which, he conceives, is peculiar to fracture of 

 the neck of the thigh-bone. In these cases 

 Mr. Colles has found a thin cartilaginous plate 

 every where interposed between the neck and 

 shaft. The new osseous production could have 

 very little assisted in keeping the fractured 

 pieces in apposition, for it was principally 

 thrown out about the trochanters, a small por- 

 tion only being formed below the neck, yet the 

 motion allowed between the fragments was so 

 very inconsiderable, that it required a close in- 

 spection to discern it, so that, in this instance, 

 the new osseous matter contributed very little 

 to the consolidation of the broken bone, the 

 firmness of which (inferior only to bony anchy- 

 losis) must therefore be ascribed entirely to the 

 interposed thin plate of cartilage. In one of 

 Mr. Colles's cases, No. XI. a vertical section 

 shewed that the neck had been fractured near 

 to the trochanters, and lay across the top of the 

 shaft ; its broken extremity being in contact 

 with the outer plate of the shaft. The external 

 solid walls of the neck were very thin.* In a 

 specimen of fracture of the cervix femoris, 

 which we possess in our museum, the neck of 

 the bone has been broken at its basis, near the 

 inter-trochanteric lines, and was impacted nearly 

 transversely into the cancellated structure of the 

 shaft of the femur, and the force of the fall was 

 so considerable that the upper fragment has 

 absolutely penetrated the outer wall of the tro- 

 chanter, and would have been in naked con- 

 tact with the tendon of the glutaeus maximus, 

 had it not been for the existence of the bursa. 

 there situated. 



From the specimens that we have examined, 

 and have in our possession, we entertain no 

 doubt but that solid bony union may take 

 place between the impacted cervix femoris and 

 the superior extremity of the shaft of the femur. 

 In all cases of the impacted fracture, when the 

 patient had survived the accident for a month 

 or more, whether the union was complete or 

 incomplete, exuberant growth of bone had 

 sprung from the inter-trochanteric lines. 



Does bony consolidation of the intra-capsular 

 fracture of the cervix femoris ever occur ? 

 This question has for the last twenty years been 



* Dublin Hospital Reports, vol. ii. p. 351. 



