Contributions to medical science / by Alexander Ogston, M.D.

  • Ogston, Alexander, Sir, 1844-1929.
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to medical science / by Alexander Ogston, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    but tlie specimens ia my possession, four in number, bear out the statement fully, and two other preparations, the only speci- mens of extra-capsular fracture in the University Pathological and Infirmary Museums in Aberdeen, are equally harmonious in this respect.) It wiU be perceived that in extra-capsular fracture the bone is usually divided into three fragments, the first formed by the head and neck, the second by the greater part of the trochanter major, and the third by the shaft of the bone and a small por- tion of the trochanter major. The lines of fracture are, on the contrary, two in number, one corresponding very closely with the intertrochanteric lines and running sometimes through the centre of the trochanter minor, and the other, leaving the first fissure at the upper border of the neck of the femur, running thence downwards and a little backwards through the trochanter major, to rejoin the first fissure somewhere near the trochanter minor.— (See Fig. 2.) The displacements occurring in such a fracture are very evi- dent. The detached trochanter major is drawn upwards and backwards by the glutei medius and minimus, qiiadratus femoris, obturators, and pyriformis, and leaves between itself and the shaft a hollow, in which the fragment formed by the head and neck is placed. The shaft is also drawn upwards by the pelvic attachments of its muscles, and pushes upwards the outer end of the cervical fragment, which may besides be tilted up by the psoas and iliacus should the lesser trochanter be partially attached to this fragment, and not, as is usually the case, chiefly to the portion formed by the shaft. In this way the whole limb is shortened, the shortening being to a greater extent than in intra-capsular fracture, and the usual external rotation is effected by the usual agencies. The prominence of the trochanter major, too, appears less elevated than natural, for the two fragments being pulled away from each other, the wedge-shajDed base of the cervical fragment lies immediately below the skin, and con- sequently the distance between the acetabulum and the skin is dimiuislied. These appearances are well seen in the prepara- tions of this fracture where union has occurred. The displace- ment upwards and backwards of the trochanteric fragment, the rotation of the lower fragment, shown by the position of the lesser trochanter, and the tilted-up end of the cervical fragment, where the neck, losing its usual oblique position, has become so horizontal as to be marked above by the articulating edge of the acetabulum, are all extremely prominent. ^ This preparation where union has occurred has the following imperfect history : — An old man, coming up a cellar stairs with a heavy weight on his back, lost his footing and fell backwards down the steps. When taken up, and attended to by my father, he presented the