The insertion of the capsular ligament of the hip-joint, and its relation to intra-capsular fracture / by Geo. K. Smith.
- Smith, George K.
- Date:
- 1862
Licence: Public Domain Mark
Credit: The insertion of the capsular ligament of the hip-joint, and its relation to intra-capsular fracture / by Geo. K. Smith. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![I- | / \ nothing which can be regarded as the line of union of the fragments, the cancellated structure of the head, neck, and upper part of the shaft being almost entirely replaced by solid bone. Professor March states that— “The evidence of the fracture being intra- capsular is to be found in the existence of the original attachment of the capsular ligament, anteriorly and posteriorly, in a dried state, and may be easily examined by any one who may see tit to do so.” We have already shown that the removal of the neck, by absorption, is accompanied by a removal of the insertion of the normal capsule— a fact which is well illustrated by the insertion of the morbid capsule of this specimen. The neck has been so completely removed by absorp- tion, that the greater part of the trochanter minor is lost in its connection with the head of the bone. A portion of the conjoined tendon of the psoas magnus and iliacus internus muscles still remains, and exhibits, by its insertion, the position of the trochanter minor. The capsular ligament is inserted so far remote from its origin that it includes nearly, or quite all of the trochan- ter minor, and is so closely blended with the con- joined tendon of the psoas and iliacus muscles that this tendon seems to form a part of the morbid capsule. The insertion of the capsular ligament of this specimen cannot be regarded as its “original attachment,” and so little of the neck still remains that, if the supposed line of union be located at any point between the head and the shaft of the bone, it will be in a great degree external to the normal capsule, and con- sequently extra-capsular, even though it is in- cluded by the morbid capsule of the specimen. At a meeting of the New York State Medical Society for the year 1860, Daniel Holmes, M.D., of Canton, Bradford County, Pennsylvania, ex- hibited a specimen as an illustration of bony union of intra-capsular fracture of the neck of the femur. The following is extracted from the report of the case published in the Transactions of the Society, page 80:— “In the evening of July 19th, 1859, I wras called in haste to see Mrs. C. W., who had just received an injury by falling on the floor; and as her residence was near at hand, I reached it in a short time. I found her lying on the bed with both limbs extended. She complained of pain in the left groin and down the limb, which was aggravated by motion and by pressure on the trochanter. “I learned that as she was about to retire, she extinguished her light; but wishing to sit down a moment, she placed her right hand on the left i arm of her chair, supposing it to be the right | arm thus missing the chair she came to the floor with her whole weight on the left hip. The left lower limb being wholly disabled by the fall, 1 - she was taken up and laid upon the bed. The in limb was measured and found to be one-half of a an inch shorter than the other. L “The toes were everted, and by placing one of my hands on the trochanter, and grasping the f9 limb, and by rotating it with the other, I dis- M covered a distinct crepitus. I then gave a posi- L tive diagnosis of fracture of the neck of the L femur, and probably within the capsule. “About the middle of the eleventh week, just 09 as we were about to make the experiment of li( having her sit up, and to try the strength of the 4 limb, a large carbuncle made its appearance on ], the upper part of the sacral and lower lumbar region. A large slough soon came out, extend- 11 ing in depth to the ligaments of the sacrum. In * spite of all restorative means, the powers of life si soon began to falter, and she expired on the 17th j( of October, fourteen weeks and three days from the time the injury was received. “A post-mortem examination, on the 18th, proved the correctness of the diagnosis. It re- ts vealed a fracture of the neck of the femur, wholly a within the capsule, which was restored by bony . union, and sufficiently strong to almost support ' the weight of the body. The coaptation of the 3 extremities of the fracture was nearly perfect, and !l had the patient survived to have used the limb, i its length would have been nearly perfect.” Dr. Holmes not only exhibited this specimen at » the New York State Medical Society, but also f presented it at the meeting of the American M ed- H ical Association at New Haven, in the summer of » 1860, and again before the Southern Central Med- ical Association, in Binghamton, Broome County, If New York. In each of these societies he was f met with the objection that the fragments might - possibly be united by ligamentous, instead of bony material, and was urged to prove his statements by macerating or boiling the fractured bone. = This he neglected to do. About three months t since T addressed a note to Dr. Holmes, informing him that I was preparing a paper on the subject of intra-capsular fracture of the neck of the femur, and requesting definite measurements of his spe- cimen, showing the distance of the line of union from the inter-trochanteric lines. I also inquired if the specimen had ever been macerated or boiled to prove that the bond of union was bony instead of ligamentous, and requested that, if it had not been submitted to such a test, he would boil it for some hours, and inform me of the result. This note remains unanswered. However reluctant Dr. Holmes may be to sub-](https://iiif.wellcomecollection.org/image/b22345450_0030.jp2/full/800%2C/0/default.jpg)
