Dislocation of Femur 469 



but this is due partly to further excavation of the acetabulum, partly 

 to caries of the head and neck of the bone, and partly to the disease 

 having arrested growth at the upper epiphysis (v. p. 461). Often in 

 an advanced case of disease with apparent dislocation, as the surgeon 

 proceeds to excise the head of the femur, he finds that it has already 

 been carried away by molecular disintegration, the top of the great tro- 

 chanter being high above the acetabulum. Thus there is no head to 

 be dislocated, and no proper socket from which, or capsule through 

 which, it could be dislocated were it present. 



Excision of head of femur may be performed through a long in- 

 cision over the great trochanter, or by one passing through the gluteus 

 maximus. The latter site offers advantages for drainage. The knife 

 should be used but little after the fascia lata has been traversed, the soft 

 parts being thrust aside and the muscles detached by a strong raspa- 

 tory. The bone may be divided above or below the great trochanter, 

 according to circumstances. If the bone be much diseased, and the 

 trochanteric part of the shaft be taken away, the following muscles 

 must be partially or entirely detached : From the shaft the gluteus 

 maximus, vastus externus, crureus, and pectineus ; from the great 

 trochanter, the gluteus medius and minimus, pyriformis, gemelli and 

 obturators, and quadratus femoris ; from the lesser trochanter, the 

 psoas and iliacus.* 



When excision is being performed for disease in childhood, the 

 great trochanter with the attachments of the gluteus medius and 

 minimus is frequently detached, but unless it be diseased it need not 

 be taken away. 



Resection by the anterior vietJwd is performed by attacking the 

 joint between the tensor fasciae femoris and the glutei on the outer 

 side, and the sartorius and rectus on the inner, the Y ligament and the 

 front of the capsule being traversed. 



Amputation at the hip-joint by transfixion is an operation of 

 the past ; Furneaux Jordan's method has superseded it. The latter 

 operation consists in making a vertical incision on to the femur from 

 above the great trochanter, and a third of the way down the thigh. 

 Bleeding vessels in this longitudinal wound are secured one by one. The 

 upper third of the femur is cleared of muscular attachments and dis- 

 articulated, the bared part being brought out of the wound by adduct- 

 ing the thigh. The assistant then grasps the hollow shell of the soft 

 parts, firmly compressing all the vessels in them, and the surgeon cuts 

 it with a circular sweep. The limb being thus amputated, the vessels 

 are leisurely secured ; the bleeding is very slight. In a case in which 

 I enucleated a femur from the periosteum, the upper fourth of a new 

 thigh-bone became developed in the long stump. 1 



Dislocations of the femur are rare, for the hip-joint is planned for 



1 Proceedings of Med. Soc. Lond. vol. ix. p. 205. 



