A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations.

  • Smith, Robert William.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    us to form the diagnosis of fracture external to the capsule, with fracture and displacement of one or both trochanters. There is one remarkable circumstance which appears to have escaped the observation of those who have described injuries such as those now alluded to, accompanied by inversion of the foot, and which appears to support the opinion that this symptom is to be ascribed to the relative position of the fragments, rather than to the influence of muscular action. I have observed it several times, and it is this: the deformity having been removed, and the limb restored to its natural length by extension, as soon as the ex- tending force ceases to act, though the limb is again shortened, the foot will be found to remain everted. Why should this be so, if muscular action had been the sole, or even the chief cause of the inversion in the first instance? In other fractures, accompa- nied by deformity, the result of muscular action, if deformity recurs after having been removed by extension, it will be found to present the same features, or nearly so, as those which, in the first instance, characterized the injury. I know of no instance in which, under such circumstances, it will not only not present similar features, but exhibit actually opposite characters. Mus- cular action, therefore, is not of itself sufficient to explain the occurrence of inversion of the foot, in cases of fracture of the neck of the femur, no matter where situated; and it has been justly observed by Cruveilhier, in reference to this subject, de- viation du pied devrait etre toujour la meme, si elle tenait a une cause identique, faction musculaire. Inversion of the foot may accompany fractures within the capsule, as well as those external to it; of this I have myself seen two examples, and Stanley, Cruveilhier, &c., have mentioned similar cases. A middle-aged man fell in the street, and his hip struck the curb-stone. The immediate consequences were that the limb was inverted, and shortened to the extent of an inch, and no crepitus could be discovered. It was presumed that a dislocation had occurred, and accordingly an extension of the limb was made. The constitutional irritation occasioned by re- peated trials to reduce the supposed dislocation was such, that the man died five months from the time of the occurrence of the acci- dent. In the dissection of the hip, a fracture was found, ex-