ABNORMAL CONDITIONS OF THE HIP-JOINT. 



820 



published by Mr. Bransby Cooper* as one 

 of dislocation on the dorsum ilii, was ra- 

 ther the dislocation we are now considering, 

 namely, the luxation towards the ischiatic 

 notch. Among some of this patient's symp- 

 toms, it is mentioned that the trochanter major 

 was plainly felt behind and a little above the 

 natural situation with respect to the ilium ; the 

 head of the bone could be felt neither in the 

 sitting, standing, nor lying posture. Indeed, 

 Mr. B. Cooper himself remarks that, " upon 

 taking into consideration all these diagnostic 

 marks, I was induced to consider the acci- 

 dent a luxation on the dorsum of the ilium; 

 although the head of the bone was not drawn 

 up so high as usual, as indicated by the slight 

 shortening of the limb; and the trochanter 

 major was also drawn further backwards than 

 is usual, in the dislocation on the dorsum, so 

 that, perhaps, this might by some surgeons have 

 been described as a dislocation to the ischiatic 

 notch." Mr. Cooper further adds : "I doubt, 

 however, if this appellation as applied to a cer- 

 tain variety of dislocation of the hip, does not 

 rather mystify than facilitate our diagnosis, 

 for it leads to the supposition that the head of 

 the bone sinks into the osseous hiatus, a cir- 

 cumstance which could not occur even in the 

 skeleton itself, from the size of the head of the 

 bone, and much less could it happen in the 

 living subject, when this notch is filled up 

 with ligaments, muscles, vessels, and nerves." 

 This respectable surgeon proposes, therefore, 

 to expunge from the classification of dislocations 

 the luxation into the notch, but to consider it 

 only as a variety of the dislocation on the 

 dorsum ilii, distinguishing the one as a luxation 

 upwards, the other backwards, on the dorsum. 

 To this proposition we cannot by any means 

 assent, for we consider that a dislocation back- 

 wards behind the ischium, and to the ischiatic 

 notch which is below the level of the ilium, 

 never can be properly designated a variety of 

 the dislocation on the dorsum ilii, although we 

 might assent to the proposition to consider it a 

 variety of the dislocation backwards. The 

 case as described by Sir A. Cooper, of disloca- 

 tion on the sciatic notch, we are satisfied is to 

 be seen occasionally, though rarely, in the living; 

 and the dissection made by Sir Astley himself, 

 in which he found the head of the bone resting 

 behind the acetabulum on the pyriform muscle, 

 tlie preparation of which is to be found in the 

 museum of St. Thomas's Hospital, should, 

 we imagine, place the matter beyond dispute. 



Anatomical characters. We have, says Sir 

 Astley Cooper, a good specimen in the collec- 

 tion of St. Thomas's Hospital, which I met 

 accidentally in a subject brought for dissection. 

 The original acetabulum is entirely filled with a 

 ligamentous substance, so that the head of the 

 bone could not have been returned into it. The 

 capsular ligament is torn from its connection 

 with the acetabulum at its anterior and posterior 

 junction, but not at its superior and inferior. 

 The ligamentum teres is broken, arid an inch of 



* Guy's Hosp. Reports, Jan. 1836. 



it still adheres to the head of the bone. The 

 head of the bone rests behind the acetabulum, 

 on the pyriformis muscle, at the edge of the 

 notch above the sacro-sciatic ligaments. The 

 muscle on which it rests is diminished, but 

 there has been no attempt made to form a new 

 bony socket for the head of the os femoris. 

 Fig. 324. 



Around the head of the thigh-bone a new 

 capsular ligament is formed ; it does not adhere 

 to the articular cartilage of the ball of the 

 bone which it surrounds, but could, when 

 opened, be turned back to the neck of the 

 thigh-bone, so as to leave its head completely 

 exposed. 



Fig. 324. 



Luxation in the sciatic notch.* 



Within the new capsular ligament, which is 

 formed of the surrounding cellular membrane, 

 the broken ligamentum teres is found. The 

 trochanter major is rather behind the acetabu- 

 lum, but inclined towards it relatively to the 

 head of the bone. This dislocation, he adds, 

 must have existed, from the appearances of the 

 parts, many years. The adhesions were too 

 strong to have admitted of any reduction, and 

 if reduced, the bone could not have remained 

 in its original socket. 



c. Luxation upwards and inwards on the 

 pubcs. This luxation is more easy of detection 

 than any other of the thigh. It happens from a 

 person while walking putting his foot into 

 some unexpected hollow in the ground, and 

 his body at the moment being bent backwards, 

 the head of the bone is thrown forward upon 

 the os pubis. 



The limb in this species of dislocation is 

 an inch shorter than the unaffected one; the 

 knee and the foot are turned -outward, and 



* From Sir A. Cooper, pi. iv. on Fractures and 

 Dislocations. 



