ABNORMAL CONDITIONS OF THE HIP-JOINT. 



823 



femur into the foramen ovale I saw in Steevens's 

 Hospital, and my friend Dr. Osbrey has obliged 

 me with his notes of the case, which were as 

 follows : 



Michael Murphy, set. 21, a labourer, ad- 

 mitted June 4th, 1834, under Mr. Colles with 

 dislocation of the head of the femur into the 

 foramen ovale. 



He stands with his entire weight upon the 

 sound side, the left thigh flexed on the pelvis, 

 his knee bent, and toes turned out and resting 

 on the ground, from which the heel is raised ; 

 the thigh is abducted so that he cannot bring 

 his knees nearer than within five inches of 

 each other, when standing up not within nine, 

 and at this time his toes are thirteen inches 

 asunder; the thigh is wasted, and he cannot 

 support any weight on the limb. When asked 

 to walk without support he places his hand 

 firmly on the knee, and bears his weight on 

 the arm and leg without throwing any of it on 

 the thigh. His pelvis is lower on the injured 

 side, and there is a slight curvature of the 

 spine, the convexity to the same side, in conse- 

 quence of which there is great apparent length- 

 ening of the limb. The real difference when 

 measured from the symphysis pubis to the point 

 of the inner ankle is two inches and a half, but 

 there is little or no difference when measured 

 from the spine of the ilium ; and when the 

 measurement is taken from the tuber ischii the 

 dislocated limb is two inches longer than its 

 fellow. There is considerable deformity about 

 the joint; a deep hollow exists immediately 

 below the anterior spine of the ilium, through 

 which the sartorius runs obliquely, joining a 

 prominent ridge when the muscle is in action. 

 The prominence of the trochanter is altogether 

 lost, and that process can be with difficulty 

 felt. The fold of the buttock is completely 

 obliterated, and there is a fullness towards the 

 upper and back part of the thigh, caused by 

 the head of the bone, which can -be felt through 

 the adductor muscles, and seems to be situated 

 further inwards than is usually described in 

 this accident. He states that he received the 

 injury five weeks ago; he was thrown down on 

 his right side obliquely against a wall, by a 

 horse running away with a cart, and the wheel 

 of the cart passed over his left hip above the 

 trochanter ; he felt great pain at the time which 

 was chiefly referred to the inside of the knee. 

 He was carried home and nothing was done 

 for him for a fortnight, when he went to a 

 hospital, where several attempts were made at 

 reduction ; all, however, failed, and after re- 

 maining there a fortnight longer he came up to 

 Dublin in the state above described. 



On the 12th of June two attempts to reduce 

 the bone failed altogether, and the man returned 

 to the country. 



Anatomical characters. It seems probable 

 that the head of the dislocated femur passes so 

 much forwards and inwards from the acetabu- 

 lum as to be in contact with the inner margin 

 of the thyroid foramen, where this foramen is 

 completed by the rami of the ischium and 

 uubes. The convexity of the great trochanter 



has the acetabulum behind it, and the lesser 

 trochanter is placed immediately external and 

 anterior to the tuberosity of the ischium. The 

 ligamentum teresand lower part of the capsular 

 ligament have been torn through, and the head 

 of the bone " become situated in the interior 

 and inner part of the thigh upon the obturator 

 externus muscle." 



We have, says Sir Astley Cooper, an ex- 

 cellent specimen of this accident in the collec- 

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

 many years ago. The head of the thigh-bone 

 was found resting on the foramen ovale, but 

 the obturator externus muscle was completely 

 absorbed, as well as the ligament naturally 

 occupying the foramen now entirely filled by 

 bone. Around the foramen ovale bony matter 

 was deposited so as to form a deep cup, in 

 which the head of the thigh-bone was inclosed, 

 but in such a manner as to allow considerable 

 motion ; and the cup thus formed surrounded 

 the neck of the thigh-bone without touching it, 

 and so enclosed its head that it could not be 

 removed from its new socket without breaking 

 its edges. The inner side of this new cup was 

 extremely smooth, not having the least ossified 

 projection at any part to impede the motion of 

 the head of the bone, which was only restrained 

 by the muscles from extensive movements. 



The original acetabulum was half filled by- 

 bone, so that it could not have received the 

 ball of the thigh-bone if it had been put back into 

 its natural situation (fig. 327). The head of the 

 thigh-bone was very little altered, its articular 



Fig. 327. 



Luxation into the foramen ovale.* 

 * From Sir A. Cooper, pi. ii. 



