File:A practical treatise on fractures and dislocations (1912) (14804773183).jpg

Identifier: practicalt00stim (find matches)
Title: A practical treatise on fractures and dislocations
Year: 1912 (1910s)
Authors: Stimson, Lewis Atterbury, 1844-1917
Subjects: Fractures Dislocations
Publisher: New York, Philadelphia, Lea & Febiger
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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evenby the psoas-iliacus, the tendon of which, instead of passing down-ward, curves around the brim of the pelvis, and passes upward, out-ward, and backward to the lesser trochanter, which is now at a higherlevel than the acetabulum. The head of the femur may be separated from the ilium by the inter-posed capsule, so that the support is entirely by suspension, and thereis no real joint, one in which bony surfaces covered with cartilage playupon each other; or the upper and posterior attachment of the capsulemay still be found above the head of the femur, upon an overgrowthof bone springing from the ilium and forming the upper part of a newsocket, the remainder of which is constituted by the body of the ilium.The latter bone sometimes shows at this point an overgrowth of bone,and sometimes a depression with a corresponding thickening on theopposite, inner surface. In the former of these two last-named con-ditions, it seems probable that the capsule has been for a time inter- PLATE XXIX
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Congenital Dislocation of the Hip. PATHOLOGY OF CONGENITAL DISLOCATIONS. 537 posed between the femur and the ilium, and has finally disappeared atthis point under pressure, the irritation of which has caused the out-growth of bone before its periosteum has in turn disap))eared ; in thelatter, it is probable that the attachment of the capsule has been pushedback step by step, leaving a bare surface of bone which has wornaway under the pressure of the femur, or by absorption ; while the asso-ciated irritation has led to a conservative thickening on its other side.The communication between the cavity of the capsule about the headand the acetabulum is through a narrowed portion, so that the wholeis like an hour-glass. The old acetabulum is narrow and elongated,running upward and backward ; the ligamentum teres perhaps destroyedby over-stretching. The entire pelvis is also changed in shape by the abnormal directionof the pressure to which it is subjected in walking. If the dislocationis un

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