ABNORMAL CONDITIONS OF THE HIP-JOINT. 



813 



has satisfied himself that osseous union some- 

 times takes place, and he has in his own col- 

 lection a most unequivocal specimen of it, 

 which he was kind enough to show me two 

 years ago. The possibility of bony union is 

 now universally acknowledged, but the cure in 

 this way is far less frequent than that by means 

 of a ligamentary connexion."* 



It does not appear to us that this question is 

 yet so entirely settled as the last writer's obser- 

 vations would lead us to imagine ; although in 

 this city (Dublin) the subject has been care- 

 fully investigated for many years, we do not 

 find our museums yet contain a single speci- 

 men of the intra-capsular fracture united by 

 bone. In Paris we find Cruveilhier, one of 

 the most eminent pathologists in France, ex- 

 pressing himself in the most unreserved manner, 

 that a bony consolidation of the intra-capsular 

 fracture was impossible. Not unaware, as must 

 be supposed, of the eight cases referred to by 

 his pupil, M. Chassaignac,f (amongst which are 

 those of Langstaff, Stanley, and Sir A. Cooper,) 

 Cruveilhier, to whom Chassaignac's memoir is 

 dedicated, thus expresses himself: "Je suis 

 porte a considerer comme des cas de deforma- 

 tion de la tete et du col, la plupart, si non la 

 totalite des fails, que Ton invoque generalement 

 pour etablir la reunion de fractures intra-cap- 

 sulaires du col du femur, a 1'aide d'un cal os- 

 seux, le cal est impossible, parceque les frag- 

 menslibres, au milieu de la synovie,ne sont point 

 entoures des tissues charges de la reparation de 

 la solution de continuite." Thus not content 

 with asserting that bony union is impossible, 

 he further adds that he is convinced from nu- 

 merous pathological observations, and from ex- 

 periments on animals, that the ideas of bony 

 union by means of a first, a provisional callus, 

 and then by means of a final callus, are erro- 

 neous ; he is certain that there is but one and 

 the same callus, which passes through different 

 stages of development, until the ossification is 

 complete ; he is of opinion that the ends of the 

 broken bone, no matter how confronted or held 

 together, never are directly united. This union, 

 he thinks, can only take place through the in- 

 tervention of callus, which is always thrown 

 round the bones where fractured, like a clasp or 

 bony ferule ; therefore, he reasons, the cause of 

 the difference between the intra-capsular and 

 extra-capsular fracture, with reference to their 

 susceptibility of bony consolidation, is, that in 

 the first the fragments are as it were abandoned 

 to themselves to effect an union ; here there is 

 no bony ferule or clasp possible, while in the 

 second the fragments are in the same condition 

 as in all other fractures ; that is to say, they are 

 surrounded by soft parts, by the ossification of 

 which the bony clasp is formed. Thus does 

 he not only deny the possibility of bony conso- 

 lidation in the case of the intra-capsular fracture, 

 but endeavours to explain why the union is 

 impracticable. 



We cannot agree with this eminent patholo- 

 gist in the observations that the ends of the 



* Loc. cit. 



t De la Fracture du col du femur. Par E. Chas- 

 saignac, M.D., Paris, 1835. 



bones themselves take no part in effecting a 

 bony union, for in cases of impacted fracture 

 alluded to by us in a preceding article, particu- 

 larly in the case of Sherlock, from which 

 fig. 320 has been taken, bony consolidation had 

 taken place in almost the whole line of the 

 fracture, and could only have been effected 

 by the union of the two bony surfaces which 

 were confronted to each other. No doubt the 

 union here was further fortified by the external 

 effusion of new callus, which surrounded the 

 bone at the seat of the fracture. When we re- 

 flect on the cases adduced in proof of the bony 

 consolidation of the intra-capsular fracture, we 

 must either disbelieve the facts, or admit that 

 the union is not impossible. 



It would have been satisfactory if the test by 

 boiling the specimens of the united fractures 

 had been resorted to in all these cases, as it had 

 been in Mr. LangstafFs ; this observation par- 

 ticularly applies to the case reported by Dr. 

 Brulalour. of Bourdeaux. We find in Chas- 

 saignac's report of this same case, taken from 

 the memoir sent to the Academy of Medicine 

 of Paris, (Seancedu 16 Avril, 1827) in alluding 

 to the specimen in question he says : " Scie, 

 dans toute sa longueur le cal se presentait sous 

 la forme d'une ligne oblique, raboteuse, d'une 

 couleurmoins blanche etd'un consistence uu 

 peu moins ferme que le reste de 1'os." 



We had thus far entered into this much agi- 

 tated question, when an interesting opportunity 

 occurred to us of making the post-mortem exa- 

 mination of a case of united intra-capsular 

 fracture. The history of the case was this : 



Owen Curran, set. 70, was for the last five 

 years an inmate of the pauper department of 

 the House of Industry ; he was very infirm on 

 his limbs, and his mind was in a state of 

 dotage; on the 1st of August, 1837, while 

 walking across his ward, he fell on his right 

 side ; he was unable to rise, and complained of 

 pain in his right hip; he was carried to bed, 

 and was immediately visited by the late Mr. 

 William Johnstone, who was then acting for 

 me as clinical pupil, who found the limb 

 everted, and only half an inch shorter than 

 the other. Mr. Johnstone considered the case 

 a fracture of the cervix femoris, which required 

 no other surgical treatment than that of placing 

 and preserving the limb in a semiflexed po- 

 sition over pillows. The old man suffered but 

 little pain in the injured part, at all events he 

 did not complain of it. In about five weeks 

 after the accident he was raised out of his bed, 

 and when placed standing, he was able to put 

 the heel of the injured limb to the ground. On 

 the 30th of September, that is, about eight 

 weeks after the accident, my friend Mr. Smith 

 entered in his note-book the following memo- 

 randum of this case : " As the patient lies in 

 bed he can elevate the injured \irnb by the un- 

 assisted efforts of its own muscles. The ever- 

 sion is slight, and the degree of shortening 

 amounts to one inch ; no force can bring the 

 limb down to the length of the other. From 

 the history and symptoms, this seems to have 

 been a case of impacted fracture." This man 

 survived the accident one year and nearly 



