822 



ABNORMAL CONDITIONS OF THE HIP-JOINT. 



upon the iliacus interims and psoas muscles. 

 The head and neck of the thigh-bone are 

 flattened, and much changed in their form. 

 Upon the pubes a new acetabulum is formed 

 for the neck of the thigh-bone, for the head of 

 the bone is above the level of the pubes. The 

 new acetabulum extended upon each side of 

 the neck of the bone, so as to lock it in a cer- 

 tain direction upon the pubes. Poupart's 

 ligament confines it on the fore-part ; on the 

 inner side of the neck of the bone passed the 

 artery and vein, so that the head of the bone 

 was seated between the crural sheath, and the 

 anterior and inferior spinous process of the 

 ilium. 



d. Luxation downwards and inwards into the 

 foramen ovale. When the femur is in a forced 

 state of abduction, if violence be in any man- 

 ner applied so as still further to exaggerate this 

 movement, the head of the femur having pre- 

 viously glided from above downwards in the 

 acetabulum to its utmost, applies itself to the 

 interior of the capsular ligament, which it 

 stretches ; if the force be continued the capsule 

 soon gives way, and the head of the femur, 

 bursting through the rent, is dislocated and 

 lodged in front of the obturator foramen. 



The symptoms by which we recognize this 

 accident are very well marked, as the limb in 

 this dislocation is two inches longer than the 

 other. The body is bent forwards owing to the 

 psoas and iliacus interims muscles being put 

 upon the stretch (Jig. 326). The knee is consi- 

 derably ad vanced ; if the body be erect it is widely 

 separated from the other, and cannot be brought 

 without great difficulty towards the middle line 

 or made to touch the other knee, owing to the 

 extension of the glutsei and pyriform muscles. 

 The foot, though widely separated from the 

 other, is generally neither turned outwards nor 

 inwards, although it varies a little in this respect 

 in different instances, but the position of the 

 foot does not in this case mark the accident. 

 The adductor muscles are elongated and form 

 a round prominent line which extends from the 

 pubes to the middle of the thigh. The foot 

 and the knee are turned outwards because the 

 adductor and the other muscles which execute 

 the movement of rotation outwards are on the 

 stretch and elongated. The thigh cannot be 

 adducted, and when we wish to communicate 

 this movement to the limb the patient feels 

 severe pains because of the tension which the 

 glutaei and rotators outwards suffer. The reason 

 of the flexion of the leg is two-fold ; first to 

 relax the hamstring muscles which are put 

 upon the stretch by the dislocation, and to 

 establish an approach to an equality in the 

 length of the limb. 



When we examine closely the injured hip, 

 we notice a considerable hollow at the upper 

 and outer part of the thigh where the great 

 trochanter is normally seen projecting, and a 

 depression is noticed below the centre of Pou- 

 part's ligament. The head of the dislocated 

 bone can be felt occasionally at the inner and 

 outer parts of the thigh towards the perineum. 

 The position of the head of the bone is below 



Fig. 326. 



Luxation into the foramen ovale. 



the acetabulum and a little anterior to it. The 

 bent position of the body, the separated knees, 

 and the increased length of the limb constitute 

 the striking and characteristic features of this 

 rare accident. 



That excellent practical surgeon, Mr. Hey 

 of Leeds, had not during a period of public 

 and private practice for thirty-eight years seen 

 a case of this accident of luxation downwards 

 and inwards into the foramen ovale, until in 

 the year 1797 three patients were brought into 

 the infirmary of Leeds. In one of the best 

 marked examples of this accident the dislocated 

 thigh appeared much thicker at the superior 

 part than the other; the adductor muscles, it 

 appears, were upon the stretch, and the inguinal 

 hollow we can collect was effaced (perhaps by 

 the tension of the skin and effusion). Mr. Hey 

 says, the head of the bone could not be dis- 

 tinctly felt through the muscles ; yet, from the 

 appearance and the touch, it was sufficiently 

 evident that the head of the bone lay upon the 

 great foramen of the os innominatum. It 

 seemed probable that it had passed so far from 

 the acetabulum as to be in contact with the 

 descending part of the os pubis. 



There was in this case a considerable hollow 

 at the upper and outer part of the thigh where 

 the great trochanter is usually felt projecting. 



The following case of dislocation of the 



