Anatomical and physiological observations (continued) / by John Struthers.

  • Struthers, John, 1823-1899.
Date:
[1858?]
Catalogue details

Licence: Public Domain Mark

Credit: Anatomical and physiological observations (continued) / by John Struthers. 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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    siderable extent, by a movement of adduction, and reflect that this is naturally prevented by the abductor muscles, we shall finally be inclined to agree with Dr Knox’s more recent opinion, expressed in his Manual of Anatomy, that “ the functions of the round ligament have not been satisfactorily determined.” It occurred to me to expose the ligament from behind, by re- moving the floor of the acetabulum, while the capsular ligament was left entire. The round ligament could now be seen in its natural position; and, by putting the joint through its various motions, the condition of the ligament in each became a matter of simple demonstration. I found that it is not tight either in adduction, or in rotation, inwards or outwards, all of which are checked by parts of the capsular ligament; and, that it is rendered tight in one position only, viz., when rotation outwards is combined with flexion. I now proceed to show, more particularly, that the use of the round ligament is to check this combined movement. How to expose the ligament,—With a gouge and mallet remove the bone from the greater part of the space between the obturator foramen and the great sciatic notch, as seen in fig. 8. The cut should reach upwards, so as to encroach upon the horizontal ramus of the pubes, and beyond the ilio-pectineal line; approaching as near as to about a quarter of an inch from the obturator foramen, whei’e care should be taken to avoid injuring the origins of the round liga- ment, which lie opposite rather more than the upper or anterior half of the obturator foramen. The opening should become smaller and rounder as it approaches the acetabulum. The bone is very thin opposite the ligament, but so thick behind and above, that a sloping cut is required. The fatty tissue and synovial membrane, forming the Haversian cushion, being picked away, the round liga- ment will be exposed down to near its origin. Any loose synovial or fatty tissue on its surface may be removed, so as to expose the fibres of the ligament proper. It is now evident that the ordinary direction of the ligament is vertical; I mean, when the limb is straight, as in standing erect, or as the body lies on the table. Also, that the ligament, in the greater part of its length, is of a rounded form, soft or pulpy, and more or less twisted, except in that position which tightens it, when it assumes the foim of a straight-fibred thick belt. The depression on the head of the femur is not simply a pit for the insertion of the ligament. Draw two lines across the middle