A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations / [Robert William Smith].

Robert William Smith

Date:: 1850

Credit: A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations / [Robert William Smith]. Source: Wellcome Collection.

18/334 page 2

$which is sufficiently attested by the number of the memoirs that have been devoted to its consideration. _ In the majority of cases of fracture of the neck of the femur, the nature of the injury is announced by symptoms sufficiently striking, and equally remarkable, whether we examine the limb while the patient is in a recumbent posture, lying upon a hori- zontal plane, or while he is supported in the erect position, rest- ing the weight of his body upon the uninjured limb. When we make the examination as the patient lies in bed, we observe that the injured limb is shortened; that the heel corresponds to some part of the region between the tendo Achillis and the internal malleolus of the sound side; that the foot is everted, and that the entire limb rests upon its external surface; the knee-joint is slightly flexed; an unnatural fulness is seen in the inguinal region, and the upper and outer part of the thigh presents an unusual convexity, and a certain amount of tension; the patient complains of pain throughout the whole of the region of the hip- joint, and in the vicinity of the insertion of the psoas muscle: the pain in the latter situation is generally aggravated when the surgeon inverts the limb and flexes the thigh upon the pelvis; the trochanter major does not stand out from the pelvis as promi- nently as upon the sound side; it is approximated to the crest of the ilium, and the gluteal region is flattened. When an extend- ing force is applied to the foot, and continued sufficiently long to overcome the contraction of the muscles which draw the lower fragment of the broken bone upwards, the limb is restored to its natural length, and most of the external signs of the fracture dis- appear; but if, while the extending force still continues in action, the surgeon communicate to the limb a movement of rotation, a grating of the fragments upon each other becomes manifest, the crepitus can be felt by the hand placed upon the trochanter major, and is frequently communicated to the hand of the assistant who is extending the limb from the foot: when, however, the extending force ceases to operate, this characteristic sign of the fracture dis- appears, and the limb, once more abandoned to the uncontrolled power of the muscles, is again shortened, and the foot becomes again everted. By rotating the limb we also ascertain that the trochanter major moves in the segment of a smaller circle than$