A new operation for bony anchylosis of the hip joint with malposition of the limb by subcutaneous division of the neck of the thigh-bone / by William Adams.

Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: A new operation for bony anchylosis of the hip joint with malposition of the limb by subcutaneous division of the neck of the thigh-bone / by William Adams. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Fig. A.—Bony anchylosis of right hip joint. A section of the specimen has been made, and is shown in the Plate. The following description is from the Hospital Catalogue : “ A right os innominatum and the upper part of the cor- responding femur, showing hip disease progressing towards anchylosis. The section that has been made shows considerable destruction of the head of the femur; its upper surface is connected with the acetabulum by a quantity of loose spongy bone; and below, a dense bony bridge connects the lower margin of the acetabulum with the upper part of the shaft of the femur. Between these two points, however, a considerable interval exists between the femur and the acetabulum (best seen in the anterior section) ; and caries seems still to have been in progress on the surface of the former. Behind the seat ot anchy- losis great destruction of the ischium has also occurred ; in one place extending quite through the bone to the cavity of the pelvis. In some parts this destroyed surface has undergone repair; in others it seems still carious. The cancellated tissue of the great trochanter has been removed ; whether by caries, necrosis, or accident, is uncertain. The femur is much increased in thickness and density.”* In this specimen the shaft of the femur is Hexed directly forwards at an angle of 45°, without any appreciable abduction or adduction. The operation of dividing the neck of the thigh-bone could not have been performed in consequence of the extensive destruction of the head and neck of the bone. Fig. B.—Bony anchylosis of right hip joint incomplete, with necrosis still existing in the head of the bone, and also in the acetabulum, communicating with the pelvic cavity ; a. line of section made through the head of the bone in removing the specimen. A small circumscribed necrosis also exists in the pubic bone. In this specimen the shaft of the femur is flexed at a right angle, and ad- ducted to an extreme degree, so as to narrow the angle between the thigh-bone and the pubis to a degree which would render the operation of dividing the neck of the thigh-bone impracticable. A recent specimen not described in the published catalogue. No. 531 in MS. catalogue. Fig. C.— Bony anchylosis of left hip joint. The following description is from the Hospital Catalogue: “ All traces of the acetabulum and head of the femur are lost; and the osseous structure of the innominate is perfectly continuous with that of the femur. The anchylosis is evidently of old date ; the surface of the uniting bone is smooth and dense, and apparently everywhere healthy. A considerable quantity of new bone has been thrown out at the seat of anchylosis. In this specimen the shaft of the femur is flexed nearly at a right angle, and adducted. The operation could not have been performed in consequence of the destruc- tion of the head and neck of the bone, and fusion of the femur with the pelvic bones in the situation of the joint.f Figs. D and E.—Anterior and posterior views of bony anchylosis of left hip joint incomplete, with progressing disease, and partial displacement upwards of head of bone in a young subject. New bone has been thrown out in the line of the acetabulum at the upper part, where anchylosis is complete. In this specimen the shaft of the femur is slightly flexed, but adducted to a greater extent. The operation of dividing the neck of the thigh-bone could easily have been performed, though as disease was still progressing at some parts, it would not have been indicated. Recent specimen not described in published catalogue. No. 53*’ in MS. catalogue. * “ St. Thomas’ Hospital Museum Catalogue.” Vol. II. Pathological Anatomy, No. 48d. t ‘‘St. Thomas’ Hospital Museum Catalogue.” Vol. II. Pathological Anatomy, No. 51'n.