ABNORMAL CONDITIONS OF THE HIP-JOINT. 



811 



much agitated; Desault, Platna, and John Bell 

 long ago expressed their opinion that a fracture 

 within the capsular ligament would not admit 

 of union by callus. Sir A. Cooper HI his 

 Treatise on Dislocations and Fractures (p. 127) 

 says, " In all the examinations which I have 

 made of transverse fractures of the cervix femo- 

 ris entirely within the capsular ligament, I have 

 never met one in which a bony union had taken 

 place, or which did not admit of motion of 

 one bone upon the other. To deny its possibi- 

 lity and to maintain that no exception to the 

 general rule can take place would be presump- 

 tuous, especially when we consider the varieties 

 of direction in which a fracture may occur, and 

 the degree of violence by which it may have 

 been produced; as, for example, when the 

 fracture is through the head of the bone and 

 there is no separation of the fractured ends, or 

 when the bone is broken without its periosteum, 

 and the reflected ligament which covers its 

 neck torn, or when it is broken obliquely, 

 partly within and partly externally to the cap- 

 sular ligament; but all I wish to be understood 

 to say is, that if it ever does happen, it is an 

 extremely rare occurrence, and that I have not 

 met a single example of it." 



Sir A. Cooper's opinions, when they were 

 published, particularly in Paris, excited as- 

 tonishment, and many observations were made 

 in the clinical lectures and works of the day 

 upon the supposed error of the doctrine, that 

 the intra-capsular fracture of the neck of the 

 thigh-bone was not susceptible of bony consoli- 

 dation. Messrs. Roux, Dupuytren, and others 

 contended that they had treated many cases of 

 the intra-capsular fracture of the neck of the 

 thigh-bone successfully, and that bony consoli- 

 dation had been effected, and besides shewed 

 to their classes what they considered as decided 

 examples of such union of this fracture. They 

 did not content themselves by referring to living 

 cases, because these were likely to be ques- 

 tioned, but they produced various specimens 

 obtained by post-mortem examinations of per- 

 sons who had recovered from the effects of the 

 fracture, but had died of other disease. Some 

 of these specimens were examined by Mr. 

 Crosse, and some were sent to London to Sir 

 A. Cooper, but they failed to convince either 

 Mr. Crosse or Sir Astley that they were true 

 instances of the intra-capsular fracture consoli- 

 dated by bone. \Ve may say the same of some 

 pieparations in the museum of the Royal Col- 

 lege of Surgeons, London, which were supposed 

 to be proofs of a bony union of the neck 

 of the thigh-bone subsequent to a fracture 

 within the capsular ligament, but says Mr. 

 \Vilson, " I have attentively examined these 

 two preparations, and cannot perceive one 

 decisive proof in either of the bone having 

 been actually fractured." One of these cases 

 was published in the Edinburgh Medical and 

 Surgical Journal as an example of united 

 fracture. The writer has known many speci- 

 mens adduced as proofs of bony consolidation 

 of the intra-capsular fracture of the neck of the 

 thigh-bone, which, upon examination, were 

 found to have been the result of disease. The 



neck of the thigh-bone, we know, is greatly 

 shortened when the hip-joint is the seat of that 

 abnormal change which we have stated to be 

 the result of chronic rheumatic arthritis, but 

 in this case the previous symptoms, the history 

 of the case, and when these cannot be collected, 

 the state of the acetabulum and other appear- 

 ances, sufficiently point out the difference. 

 Again, the effect of senile degeneration -of the 

 cervix femoris is very liable to be mistaken for 

 an united intra-capsular fracture. In this, 

 however, the history of the case, the co-existence 

 of the same condition on both sides, the pene- 

 tration of the interior of the attenuated cellular 

 structure by an oily medulla, and other charac- 

 ters of the senile degeneration, will serve to 

 prevent false conclusions. Lastly, we have also 

 frequently known specimens of the impacted frac- 

 ture, where the whole cervix has been firmly 

 driven into the substance of the great trochanter, 

 mistaken for examples of bony union of the in- 

 tra-capsular fracture. The quantity of callus that 

 is in these cases added to the great and lesser 

 trochanters, which encloses the impacted neck 

 of the bone, is calculated on a superficial exami- 

 nation to induce erroneous conclusions, but a 

 section of the bone, as represented in Jig. 320, 

 will explain the true nature of the case. 



Various cases have been laid before the pub- 

 lic and read before different learned societies, 

 which have been considered as very decided 

 evidences of bony consolidation of the intra- 

 capsular fracture of the neck of the femur. 



Case 1. In the year 1827 Mr. Langstaff 

 presented to the Medico-Chirurgical Society of 

 London a specimen of what he considered to 

 have been an intra-capsular fracture united by 

 bone. The case was that of a woman who was 

 50 years of age when the fracture occurred. 

 She was confined for nearly twelve months to 

 bed after the injury, and during the remainder 

 of her life, that is, for ten years, she walked on 

 crutches. On dissection it was found that the 

 principal part of the neck of the femur was 

 absorbed, and the head and remaining portion 

 of the neck were united principally by bone, 

 and partly by a cartilaginous substance. The 

 capsular ligament was immensely thickened 

 and embraced the joint very closely, the carti- 

 laginous covering of the head of the bone and 

 acetabulum had suffered partial absorption, the 

 internal surface of the capsular ligament was 

 coated with lymph. On making a section of 

 the bone, it was evident that there had been a 

 fracture of the neck within the capsular liga- 

 ment, and that union had taken place by osseous 

 and cartilaginous media. With a view of ascer- 

 taining whether there was real osseous union the 

 bone was boiled many hours, which discoloured 

 it, but by destroying all the animal matter it 

 satisfactorily proved the extent and firmness of 

 the osseous connexion, and the vacant spaces 

 occupied with cartilaginous matter. These 

 appearances are represented by a drawing made 

 shortly after boiling.* 



Case 2. Dr Brulalour, surgeon to the hos- 

 pital at Bourdeaux, sent to London the parti- 



* Vol. xiii. of the Society's Transactions. 



