A treatise on fractures in the vicinity of joints, and on certain forms of accidental and congenital dislocations / by Robert William Smith.

  • Smith, Robert William, 1807-1873.
Date:
1847
Catalogue details

Licence: Public Domain Mark

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

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    Among the causes whicli limit tlie retraction of the limb in cases of intracapsular fractures, we must not omit to mention the powerful capsular ligament, which so closely embraces the articu- lation. Sir Astley Cooper states that, when the bone is broken within the capsule, the leg becomes from one to two inches shorter than the other. So great a degree of shortening I have never witnessed as an immediate result of the fracture, nor do I think the capsule would admit of such an amount of displacement, unless it were extensively lacerated, an occurrence which is very rare indeed, With respect to the shortening of the limb, says Mr. Earle, to the extent of two inches, as I have never witnessed such an occurrence, I cannot but conceive that there must be some inac- curacy in the statement, more especially when the great strength and unyielding nature of the capsular ligament are considered. Boyer likewise expresses the same opinion ; he says : Quand la fracture a lieu dans I'un des points de la longueur du col du femur qui correspondent a I'interieur de I'articulation, le ligament orbiculaire qui n'est jamais rompu, contre-balance les causes de displacement, et en resistant en haut et en bas a I'impulsion des deux fragmens, il borne quelquefois la raccourcissement du mem- bre a quelque lignes.* But when the fracture is external to the capsule, and not impacted, there is but little to prevent the full force of muscular action upon the lower fragment of the bone, while, at the same time, the upper is depressed by the weight of the body, so that, from these two causes, a degree of shortening may be produced equal to, or even greater than the entire length of the neck of the bone. In confirmation of his opinion of there being a comparatively slight degree of shortening in extracap- sular fractures, Sir Astley Cooper describes the case of a man who died in a fortnight after having sustained this injury. In the account of the post-mortem examination he mentions that all the limbs were rigid from the fixed contraction of the muscles, yet the broken limb was found to be not quite three-quarters of an inch shorter than the other; the fracture was external to the capsule, and the neck of the bone was forced into the cancelli of the trochanter major. Before writing this statement, Sir Astley * Traite des Maladies Chirurgicales, t. iii. p. 262.