Description of two cases of direct dislocation backwards of the femur with fracture of the rim of the acetabulum : with remarks on the mode of production of dislocations backwards / by Frederic S. Eve.

  • Eve, Frederick Samuel, Sir, 1853-1916.
Date:
1880
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Licence: Public Domain Mark

Credit: Description of two cases of direct dislocation backwards of the femur with fracture of the rim of the acetabulum : with remarks on the mode of production of dislocations backwards / by Frederic S. Eve. 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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    with the opinions of Sir Astley Cooper, Hamilton, and Bigelow, who teach that flexion and adduction is the position in which dislocations backwards occur; and reference to the description of cases clearly shows that this is the position in which a large number, probably the majority, of backward luxations take place. Further, we must assume a peculiar alternation of movements which will cause forcible inversion to follow abduction of the limb, in order that the head of the femur, after leaving the socket, may be driven upwards and backwards. These movements, as Mr. Morris explains, occurred in the case of indirect dislocation he describes, but they are complicated and not likely to happen frequently. The association of inversion with abduction appears less likely to be of frequent occurrence as the latter movement is normally associated with eversion. For example, it will be found impossible to straddle the legs widely apart, that is, abduct them, while the feet are inverted ; and if the limb were inverted while abducted and extended, the head of the bone would be driven agrainst the posterior and inferior portion of the capsule, and not against the thin portion covering the cotyloid notch. These considerations lead me to infer that abduction would at least as frequently produce dislocation forwards as dislocation backwards, since abduction is more com- monly associated with eversion in ordinary circumstances. Mr. Morris states that in the reduction of direct dis- locations, the manipulation, so successful in indirect dis- locations, would be difiicult and destructive because more of the capsule and the small rotator muscles would have to be broken down before the head could be guided round the acetabular rim to the cotyloid notch.-^ As the result of experiment I find, however, that it is not necessary in order to reduce a direct dislocation above the tendon, that the head of the femur should pass down to the cotyloid notch. If the head of the bono is thrust through a limited incision at the acetabular attachment of the capsule, above the tendon of the obturator internus, it can readily be