Spontaneous dislocation of the head of the femur into the ischiatic notch, occurring in morbus coxarius / by James R. Wood.

  • Wood, James R. (James Rushmore), 1816-1882.
Date:
[1854?]
Catalogue details

Licence: Public Domain Mark

Credit: Spontaneous dislocation of the head of the femur into the ischiatic notch, occurring in morbus coxarius / by James R. Wood. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    thigh upon the tuberosity of the pubis was so great (notwithstanding the placing of small bolsters between the thighs) that it produced slough- ing of the integuments at tbat part. The least attempt at abduction was productive of excruciating pain. Hectic fever soon commenced, and the disease as rapidly progressed. On the 17th of December, spontane- ous reduction of the dislocated femur occurred. From this time the limb remained in a state of extreme abduction, any attempt at adduction causing a great aggravation of pain, which was referred to the locality of the joint solely. The pain at the hip still continued as severe as it was before the reduction, but it was much diminished in the knee, leg, and foot. (The pain that was felt before reduction probably depended in great measure upon the pressure of the head of the bone on the sci- atic nerve; it was then as severe at the knee and foot as at the affected joint.) The sloughing still continued to extend; and she became deliri- ous, one week before death, which occurred Dec. 20th, of the same year. The postmortem section showed extravasation of blood between the transversalis muscle and the peritoneum, in the left iliac region. Under the seat of the slough, the periosteum was much inflamed and thickened, and beneath it matter had formed. The posterior part of the capsular ligament was ulcerated away, leaving an opening like a button-hole, through which, when luxated, the head of the femur had passed (this button-hole, or band, is plainly shown in the accompanying engraving); the immobility of the thigh was accounted for, Avhile the head of the bone was thus fixed. The hinder margin of the acetabulum had also ulcerated, and was absorbed sufficiently to allow the dislocation that had happened. The cavity of the joint contained considerable coagulated blood and pus; there was also a large quantity of blood infiltrated into the cellular tissue of the adductor muscles. A large abscess was discov- ered, occupying the venter of the right ilium, communicating with the acetabulum (which was ulcerated quite through), and also with the rec- tum. The ligamentum teres was destroyed, and the posterior and supe- rior part of the head of the femur ulcerated and flattened ; it was also soft, and could be penetrated by the point of the knife; the medullary sub- stance was dark-colored and softened; and the inner layer of the bone was carious, with the endosteum removed. The morbid specimen, of which the cut is a remarkably accurate representation, was exhibited at a meeting of the Academy of Medicine, and is now preserved in my pathological collection.