A treatise on fractures in the vicinity of the joints, and on certain forms of accidental and congenital dislocations.

  • Smith, Robert William.
Date:
1850
Catalogue details

Licence: Public Domain Mark

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

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    69/336 (page 51)
    with those described by Mr. Colics. I have, it is true, frequently found a considerable portion of the compact tissue which invests the posterior surface of the cervix turn from the cancellated struc- ture, and remaining adherent to the cervical ligament, which usually remains uninjured posteriorly, being, as already men- tioned, relaxed by the rotation outwards of the limb; but in the majority of such cases, this lamina of compact tissue is itself broken into two or more fragments, in consequence also of the rotation outwards of the limb, for this motion, while it divari- cates the anterior margins of the fracture, crushes, as it were, the fragments together posteriorly, and hence it is that we so often find the intracapsular fracture, although simple in front, commi- nuted behind. It would be very difficult to account satisfactorily either for the shortening of the limb or the rotation of the foot outwards, as long as we suppose the posterior part of the neck of the bone unbroken; in my opinion, the presence of shortening necessarily implies, that if there be any fracture of the neck of the bone it must be complete: no one, surely, would be disposed to main- tain that the thin stratum of compact tissue which covers the pos- terior part of the cervix femoris is likely to bend, and thus to yield without breaking, in an old person, to a force which frac- tures the remainder of the neck of the bone; and yet it is obvious that it must either bend or break, before retraction of the limb can occur. I have not been able to find in the Museum of the Royal College of Surgeons, the specimens which Mr. Colles has described as examples of partial fracture, nor is there any mention made of them in the printed Catalogue of the Museum, so that I cannot speak with confidence upon the subject; but from having myself repeatedly seen appearances very similar to those which he has described, in cases in which the fracture was undoubtedly complete, I am disposed to believe that some mistake has been committed, the exact nature of which it is now, of course, impos- sible to ascertain. It has been already mentioned that, in the great majority of cases of intracapsular fracture, the posterior portion of the cervical ligament remains uninjured, and that large fragments of the com- pact tissue of the corresponding part of the neck of the bone are fre- E 2