Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

    66/116 (page 50)
    When a man lies on his back, the top of the great tro- chanter is pretty nearly on a level with the spine of the pubes, and about three-fourths of an inch lower than the top of the head of the femur. 117. Nelaton's line.—' If in the normal state you examine the relations of the great trochanter to the other bony pro- minences of the pelvis, you will find that the top of the trochanter corresponds to a line drawn from the anterior superior spine of the ilium to the most prominent part of the tuberosity of the ischium. This line also runs through the centre of the acetabulum. The extent of displacement in dislocation or fracture is marked by the projection of the trochanter behind and above this line.5 8 ' Nelaton's line,' as it is termed, theoretically holds good. But in stout persons it is not always easy to feel these bony points so as to draw the line with precision. A surgeon must, after all, in most cases trust to measurement by his eyes and his flat hands—his best guides. Thus, let the thumbs be placed firmly on the spines of the ilia, while the fingers grasp the trochanters on each side. Having the sound side as a standard of comparison, a practised hand will easily detect any displacement on the injured side. Hippocrates bids us compare the sound parts with the parts affected (in frac- tures) and observe the inequalities. The top of the great trochanter is the guide in an opera- tion recently introduced by Mr. Adams, namely, the ' sub- cutaneous section of the neck of the femur.' ' The punc- ture should be made one inch above and nearly one inch in front of the top of the trochanter. The neck of the bone is to be sawn through at right angles to its axis, the saw working parallel to Poupart's ligament, and about one inch below it.' 118. Spine of the ilium.—The anterior superior spine of the ilium is the point from which we measure the length of the lower limb. By looking at the spines of opposite sides we can detect any slant in the pelvis. By pressure on both spines simultaneously we test a case of suspected fracture of the pelvis, or disease at the sacro-iliac joint.