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
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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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    THE INSERTION OF THE CAPSULAR LIGAMENT OF THE HIP-JOINT, And its Relation to Intra-Capsular Fracture of the Neck of the Femur. By Geo. K. Smith, M.D., Demonstrator of Anatomy in the Long Island College Hospital, Brooklyn, New York. While listening to the lectures of Professor Hamilton on Fractures and Dislocations, deliv- ered at the Long Island College Hospital, in the spring and summer of 1860, I became very much interested in the study of fracture of the neck of the femur within the capsular ligament; and, after reading considerable on that subject, I was led to wonder why it was that a given specimen, pre- sented as an illustration of bony union after frac- ture of the neck, should, when viewed by different surgeons of equal merit, give rise to such widely different and conflicting opinions: some regard- ling it as an example of bony union of intra-cap- sular fracture; some of union partly without the capsule; while others denied that the bone was ever fractured, and declared that its morbid ap- pearances were characteristic of interstitial ab- sorption. An illustration of this singular fact is seen in a case reported by Professor Mussey, of iCincinnati, in the April number of the American Journal of Medical Sciences for the year 1857. Of this specimen, Professor Mussey writes as follows:— “In the year 1830 I showed this to MM. Roux and Amussat, and some other professional gentle- men, in Paris. They regarded it as a fair specimen of bony union of intra-capsular fracture. In Lon- don I also showed it to Mr. Lawrence, Mr.Travers, Mr. Stanley, and Dr. Hodgkin, who was then Cur- ator of the Museum at Guy’s Hospital. These gentlemen were interested with the specimen, and Iconsidered it as a satisfactory example of bony union within the capsular ligament. On my pre- senting it for inspection to Sir Astley Cooper, he remarked: ‘This bone was never broken.’ I said, Sir Astley, please to look at the interior of the bone. He separated the two halves, and said: ‘This does look a little more like it, to be sure ; but I do not think it is wholly within the cap- sular ligament.’ At Edinburgh, 1 showed it to that distinguished surgeon, John Thompson, whose work on inflammation had given him ex- tensive notoriety. On carefully inspecting it, he declared, ‘upon his truth and honor,’ that it had never been broken. An opinion had prevailed for some time among surgeons, that in old per- sons the head of the thigh-bone is liable to sink below its ordinary level, with more or less short- ening of the neck, which occurs in certain morbid conditions without the aid of mechanical violence. Mr. Thompson regarded this as an instance of that kind of change.” Dr. Mussey further states that— “The professional gentlemen of our own country who have examined these specimens, unhesitat- ingly pronounce this to be a case of union by bone of intra-capsular fracture.” Some specimens have been presented as proofs of bony union, concerning which the diagnosis of fracture was never clearly made out; and, in these instances, we were not surprised that some should deny that the bone was ever fractured, and that they should regard the morbid appearances of the bone as being characteristic of interstitial absorption of the neck. I could see no satisfactory reason, however, for the difference of opinion among those who re- garded the specimen as an example of bony union; for, if the capsular attachment to the neck be definite and invariable in its location, as described by Wilson and Gray, then it seemed easy to ascertain, by actual measurement, whether the line of union in any specimen be entirely within or partly without the capsule. Here it occurred to me that there might possibly be a variation in the locality of capsular attachment to the neck; and, if so, this fact would account, in a great measure, for the endless contention of surgeons over the possibility of bony union within the capsule. This supposition was materially strengthened by the fact that, in numerous in- stances, the surgeon, who made the autopsy after union of fracture of the neck, and examined the specimen before the removal of the capsular liga- ment, was convinced that the fracture was en- tirely within the capsule; while other surgeons, equally competent to judge of the point at issue, ' who saw the specimen after the removal of the capsular ligament, were positive that the fracture was partly without the capsule. Entertaining this suspicion concerning the lo- cation of capsular attachment, I determined to ascertain, by actual observation and accurate measurement of numerous specimens of the nor- mal capsule, whether it ever varied in its inser- tion from the descriptions given by Wilson and