1436 



CLINICAL AND TOPOGRAPHICAL ANATOMY 



The slightness of the prominence of the great trochanter in the Uving subject compared with that 

 in the skeleton is explained by fig. 1154, which shows how the descending gluteus medius and 

 mini mus fill up the space between the ilium and trochanter. To examine the great trochanter, 

 the thigh should be abducted, so as to relax the strong fascia lata passing upward over the tensor 

 and glutei to the ihac crest. 



Nelaton's line. — This useful guide is a line drawn from the anterior superior 

 spine of the ilium to the most prominent part of the tuberosity of the ischium. In 

 normal limbs, the top of the great trochanter just touches this line. In dislocation, 

 fractures of the neck, and in wasting of the neck, as in osteo-arthritis, the relation 

 of the trochanter to Nelaton's line becomes altered. 



The top of the great trochanter is a guide in Adams's operation for division of the neck of an 

 ankylosed femur, the puncture being made and the saw entered 2.5 cm. (1 in.) above and about 

 the same distance in front of this point. Owing to the fact that in many cases of ankylosis 

 the neck is destroA'ed, the above operation has been largely replaced by the simpler and more 

 widely apphcable Gant's osteotomy just below the great trochanter, from the lateral side. 



Fig. 1154. — Transverse Section of the Hip-Joint and its Relations, 

 (One-third.) (Braune.) 



Femoral nerve in sub- 

 stance of iliacus 

 External iliac artery 



Ilium 



i Obturator internus— 



Adductor magnus 



Obturator externus 



Adductor longus 

 Adductor brevis- 



-" Gluteus minimus 

 — Gluteus medius 



Pectineus 

 Ilio-psoas 



Bryant's triangle. — Bryant makes use of the following in deciding the position of the great 

 trochanter. The patient being flat on his back (1) a line is dropped vertically on to the couch 

 from the anterior superior spine; (2) from the top of the great trochanter a straight line in the 

 long axis of the thigh is drawn to meet the first; (3) to complete the triangle, a line is drawn from 

 the anterior superior spine to the top of the trochanter. This line is practically N61aton's, 

 The second line will be found diminished on the damaged or diseased side. 



Muscular prominences. — The tensor fasciae laloe forms a prominence beginning just lateral 

 to the sartorius and reaching downward and somewhat backward to the strong fascia lata, 

 7.5 to 10 cm. (3 to 4 in.) below the great trochanter. Below this point, as far as the lateral con- 

 dyle of the tibia, the strong ilio-libial band can be felt. Like the inverted Y-shaped ligament, 

 this band is a powerful saving of mu.scular action in maintaining the erect position. At the in- 

 sertion of the tensor fa.scia' lata; it bifurcates into two layers, which enclose the muscle. The 

 supcrficiid is attached U> the iliac crest and \hv sheath of the gluteus medius; the deep blends with 

 the capsule and the reflected heafl of the rectus. This deeper layer is perforated by the ascend- 

 ing branch C)f the lateral circumflex. Tlu; ilio-til)ial band is a guide for reaching the femur 

 (p. 1334). The sartorius, the chief landmark of the thigh, forming a boundary of the femoral 

 trigone (Scarpa's triangle), the adductor (Hunter's) canal, and the popliteal space, can be readily 

 brought into view by the patient's raising his limb slightly rotated laterally. In the middle line 

 the rectus muscle stands out in bold rehef, with its tendon of insertion and the patella, when the 



