ABNORMAL CONDITIONS OF THE HIP-JOINT. 



817 



cases was unknown. When we carefully ex- 

 amine the author's account of them, and refer 

 to the eight accompanying drawings he has 

 given of them, doubts may well arise in the 

 mind as to whether these are to be considered 

 congenital luxations, or the result of accidents 

 which had occurred after birth. The author 

 does not himself seem free from suspicion on 

 this rfiatter, for, in commencing his observa- 

 tions on the pathological anatomy of cases of 

 luxation of the femur on the dorsum ilii, 

 upwards and outwards, he says, " elles sont 

 tantot congeniales, tantot posterieurs a la uais- 

 sance. Existe-t-il des differences notables 

 entre les unes et les autres sous le point de 

 1'anatomie pathologique ? II m'est permis 

 d'en douter jusqu'a ce que des faits positifs 

 aient etabli le contraire." We have in some of 

 the preceding pages adduced what we have 

 considered positive proofs that the anatomical 

 characters of the congenital luxation of the hip- 

 joint are altogether peculiar, and the appearances 

 either in the living or the dead are in our 

 opinion by no means to be confounded with 

 those which are the result of luxations which 

 have occurred after birth, and have been left 

 unreduced. 



When opportunities have occurred of exa- 

 mining the hip-joints of those who have for 

 many years survived a dislocation of the head 

 of the femur upwards and backwards on the 

 dorsum ilii, and which had been left unre- 

 duced, remarkable changes have been noticed 

 to have taken place in the bones and surround- 

 ing structures. 



Muscles. The muscles of the dislocated hip 

 have been found for the most part in a state 

 of comparative atrophy, and the direction of 

 their fibres has of course been altered by the 

 ascent of the superior extremity of the femur. 

 Among the muscles of the hip-joint the con- 

 dition of the glutaeus minimus has been most 

 dwelt on by authors. 



It is stated on the respectable authority of 

 Boyer, that when the head of the femur is 

 dislocated upwards and backwards on the 

 dorsurn ilii, it passes between the external 

 iliac fossa, and the little glutaeus ; that it 

 carries this muscle up, and is as it were 

 capped by it (" pour ainsi dire coiffee"). This 

 muscle, he elsewhere adds, envelopes imme- 

 diately the head of the femur ; it undergoes 

 very remarkable changes; it becomes pale; 

 its fibres disappear almost entirely, and are 

 changed into a fibrous substance which is firm 

 and solid, and which has been sometimes seen 

 converted into bone. Cmveilhier seems to have 

 adopted Boyer's idea as to the change this 

 muscle undergoes in these cases. But if it be 

 true, as we believe it is, that at the moment 

 the luxation we are now considering occurs, 

 the limb is in a state of semiflexion, we 

 shall find it difficult to conceive how the head 

 of the bone in passing can encounter any of 

 the fibres of the glutaeus medius or minimus, 

 except it be the most posterior and inferior of 

 them. 



Mr. Wallace has, in the Transactions of 



VOL. ii. 



the College of Physicians in Ireland,* given 

 a very minute and valuable account of a case 

 of dislocation of the head of the femur on the 

 dorsum ilii. The history of the case was un- 

 known ; but the state of the parts engaged left 

 no doubt on his mind that it must have been 

 many years since the bone had been dislocated, 

 and from the appearance of the body he con- 

 cluded that the subject was not less than fifty. 

 The glutaei muscles were in a state approach- 

 ing to that of atrophy : the posterior edge of 

 the glutaeus medius ran exactly over the head 

 of the femur; the texture of the glutaeus mini- 

 mus resembled adeps more than healthy mus- 

 cular fibre. 



The pyriformis did not extend to the tro- 

 chanter major, but terminated at the distance 

 of some inches from this process, in the new 

 capsule which covered the head of the femur. 

 There was not a trace of the obturator internus, 

 its place having been occupied by a quantity of 

 fat of a peculiarly gristly texture ; the quadratus 

 and geraelli were pale and small, and were 

 bisected by an irregular tendinous line. The 

 direction of these muscles between their points 

 of attachment was more oblique than natural ; 

 the psoas and iliacus were diminished in size, 

 and their line of direction from the brim of the 

 pelvis to their connexion with the lesser tro- 

 chanter was altered, as was also the direction 

 of the triceps, pectinales, and obturator extei- 

 nus, all which were carried upwards above the 

 level of their usual course by the elevation of the 

 upper extremity of the femur on the dorsum ilii. 



The femoral vessels and nerves having passed 

 under Poupart's ligament, were sunk into a 

 deep fossa, and extended backwards and out- 

 wards until they approached the lesser trochan- 

 ter ; they ran more in a serpentine or tortuous 

 course than the corresponding vessels of the 

 opposite limb ; the sciatic nerve was flattened, 

 its direction curved, and its vessels were vari- 

 cose. Its entire structure appeared as if it had 

 been the seat of chronic inflammation. 



Ligaments. In this case a very strong liga- 

 mentous fasciculus extended below the anterior 

 and lower part of the ilio-pubic eminence 

 and the lesser trochanter ; this must have per- 

 formed the function of a check ligament to the 

 motion of eversion, for any attempt at turning 

 the limb outwards rendered this ligament very 

 tense. A thick capsule surrounded the new 

 articulating surface of the ilium, and also the 

 head and neck of the femur; although the inner 

 surface of this was smeared with synovia, it 

 had not the smooth aspect of an original syno- 

 vial membrane. There was imbedded in the 

 capsule a piece of bone of a rounded figure, 

 half an inch in diameter.f There were no re- 

 mains of round ligament. 



Bones. The great trochanter was thrown 

 forwards with respect to the head of the bone : 

 the anterior internal and inferior portion of the 

 head of the femur was applied to the dorsum 

 ilii, and there was an articulating surface worn 



* Vol. V. p. 252. 



t Mr. W. imagined this to be a portion of the 

 acetabulura. 



3 H 



