The insertion of the capsular ligament of the hip-joint, and its relation to intra-capsular fracture / by Geo. K. Smith.
- Smith, George K.
- Date:
- 1862
Licence: Public Domain Mark
Credit: The insertion of the capsular ligament of the hip-joint, and its relation to intra-capsular fracture / by Geo. K. Smith. 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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![Dismissing this point, we notice that Cruveil- hier states that synovial membranes are abund- antly supplied with lymphatic vessels, thus : the origin of the lymphatics can be shown only upon free surfaces, such as the mucous mem- branes, the skin, the serous and synovial mem- branes, and the lining membranes of arteries and veins. All the lymphatics arise by a net-work of such tenuity that when injected with mercury the whole surface appears changed into a metal- lic layer. The synovial membranes may be in- jected with the greatest facility, either near the Cartilages where they are more tense than in other parts, or upon the ligaments to which they idhere.* If synovial membranes are thus abundantly sup- plied with lymphatics, it can hardly be doubted -hat there are lymphatic vessels in the ligamen- um teres which may become active agents of i-bsorption after fracture of the neck of the emur; since the ligamentum teres is enveloped hroughout its extent by synovial membrane. Iray states that “ the deep lymphatics accom- >any the deep arteries,” and that “the lymphat- cs of any part or organ exceed in number the eins, but in size they are much smaller.” If now the lymphatics originate in accordance Hth Leidy’s opinion, “in close capillary nets, itercallated with the sanguiferous capillaries,” nd pass in a direction from without inward, ac- ompanying the arteries, we can see no good eason why that branch of the obturator artery rhich supplies the head of the bone with blood «!: hould form an exception to the rule. With our resent imperfect knowledge concerning the ori- in and distribution of the lymphatics, it appears d me that the statement of Prof. Post, that iif before union takes place the head of the bone as a very imperfect supply of the veins or ?mphatics through whose agency the absorption ould be likely to occur,” is a statement which squires further anatomical investigation before •} can be admitted as a fact. Whatever the agency may he by which the esult is accomplished, absorption of the head nd neck of the hone does actually occur, with- ut any apparent attempt at union of the frag- ments; and the rapidity of the absorption is pmetimes so great that nearly the whole of the eck has been known to be removed in less time * an is required for bony union of this fracture. hus:— * Crnveilhier’s Anatomy, p. 612. “ The superior fragment of the broken cervix usually disappears to the level of the brim of the acetabulum, either in consequence of the action of the absorbent vessels, or by the friction of the broken surfaces, or perhaps it is due to a combination of both these causes. The absorp- tion, however, sometimes extends much further; I have seen half of the globular head of the bone thus removed, and a case has been recorded in which the head of the bone was completely ab- sorbed. * * * * Ju 0]d cases the femoral fragment is likewise absorbed to a greater or less extent; sometimes it disappears entirely to its base, and the portion of the shaft from which, in its normal state, it springs, presents a smooth and even surface, limited by the trochanters and their connecting lines. * * * The absorption of the lower fragment is sometimes effected with extraordinary rapidity; in case No. 9, the short- ening of the limb, which immediately followed the receipt of the injury, was only a quarter of an inch, but after the expiration of six weeks it amounted to one inch and a half; and in case No. 12, the removal of the greater part of the neck of the bone was accomplished in less than a month.”* Here we see the effect, and from the effect we infer the cause which produced it; for, although we may be unable to trace the immediate con- nection of cause and effect, we know that nature never accomplishes any purpose without employ- ing means which are adequate to the ends pro- duced. If after fracture of the neck the whole head be removed by absorption, without any attempt at union of the fragments, we are forced to conclude that the supply of veins and lymphat- ics to the head of the bone is sufficient to pro- duce this result, since it is through the agency of these vessels that absorption occurs, and we can therefore see no physiological necessity for the absorption of the neck to be preceded by bony union of the fragments. I would not, under any circumstances, knowingly put a wrong construc- tion upon the language of any surgeon, but, if I correctly understand the following proposition of Prof. Post, it does not seem to me to be strictly, in harmony with his criticism of my fifth propo- sition :— “ In intra-cervical fractures, whether bony union takes place or not, the cervix femoris becomes greatly shortened by insterstitial ab- sorption, and, after the lapse of several weeks or months, the limb may be shortened to the extent of two inches or more.” Prof. Post states that in order to demonstrate the truth of my fifth proposition “ it would be necessary to present a series of preparations](https://iiif.wellcomecollection.org/image/b22345450_0043.jp2/full/800%2C/0/default.jpg)
