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A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms Of

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A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms Of J' J^JJJ ^4WHI»*»— ' riHiM ——————— : ; ; In the Tress, and nearly ready, Fifth Edition, Fcp. 8w., THE DUBLIN DISSECTOR, OE MANUAL OF ANATOMY; COMPKISING A CONCISE DESCRIPTION OF THE BONES, MUSCLES, VESSELS, NERVES, AND VISCERA ALSO, 'Eiiz wlatibc Unatomg of tj^c liiffctcnt i^cgiong of t^c l^timan 23olig FOR THE USE OF STUDENTS IN THE DISSECTING-ROOM. By ROBERT HARRISON, M. D. New Edition, illustrated by upwards of 150 Engravings. PART L^ANATOMY OF THE MUSCULAR SYSTEM. Chap. I. Dissection of the external Parts op the Head and Face External Parts of the Head ; Dissection of the external Parts of the Face ; Vessels and Nerves of the Face. Chap. II Dissection of the Neck—Of the Muscles ; Dissection of the Vessels and Nerves of the Neck; of the Mouth, Pharynx, and Larynx; of the Pharynx; of the Palate and its Muscles ; of the Larynx ; of the deep Muscles of the Neck. Chap. Ill Dissection of the Thorax—Of the Muscles on the anterior and lateral Parts of the Thorax ; Dissection of the AxiUa ; of the Cavity of the Thorax. Chap, IV. Muscles of the Back. Chap. V Dissection of the upper Extremity Dissection of the Muscles of the Shoulder and Arm ; of the Fore-arm and Hand. Chap. VI Dissection of the Abdomen Of the Muscles on the anterior and la- teral Parts of the Abdomen; Dissection of the Viscera of the Abdomen; of the Vessels and Nerves of the Abdomen ; Dissection of the Kidney and Ureters ; of the deep Muscles of the Abdomen; of the Perinaeum in the Male ; of the Pelvis ; of the Organs of Generation in the Male. Chap. VII. Dissection of the Female Organs of Generation. Chap. VIII. Dissection of the inferior Extremities Dissection of the Muscles of the Thigh ; Muscles on the Forepart and Sides of the Thigh ; Dissection of the posterior Part of the Thigh ; of the Muscles of the Hip ; on the back Part of the Thigh ; of the Leg ; of the Muscles on the anterior and external Part of the Leg of the Muscles on the Back of the Leg ; of the Muscles of the Foot. PART II.—ANATOMY OF THE VASCULAR SYSTEM. Chap. I Anatomy of the Arteries Anatomy of the venous System ; of the foetal Circulation ; of the Thymus Body ; of the lymphatic or absorbent System. PART IIL—ANATOMY OF THE NERVOUS SYSTEM. Chap. I Dissection of the Brain—Membranes of the Brain ; Dissection of the Cerebrum; of the Cerebellum or Lesser Brain; of the Medulla Oblongata. Chap. II Dissection of the. Medulla Spinalis, or Spinal Cord.—Dissection of ; ; the Membranes of the Spinal Cord of the Spinal Cord Origin of the Spinal Nerves ; Dissection of the Brain from below ; Vessels of the Brain ; Origin of the cerebral Nerves. Chap III. Dissection of the Nerves. Chap. IV Organs of Sense. PART IV.—ANATOMY OF THE OSSEOUS SYSTEM. DUBLIN: HODGES AND SMITH, GRAFTON-STREET. LONDON: LONGMAN AND CO., AND SIMPKIN AND MARSHALL. 2^ /U S' Digitized by tine Internet Arciiive in 2011 witii funding from Open Knowledge Commons and Harvard Medical School http://www.archive.org/details/treatiseonfractu1847smit On.ojj'^ ' - -^ A TKEATISE ON FRACTURES IN THE VICINITY OF JOINTS, AND ON CERTAIN FORMS OP ACCIDENTAL AND CONGENITAL DISLOCATIONS. ROBERT WILLIAM SMITH, M. D., M. R. L A, FELLOW OF THE ROTAl COLLEGE OF StlKGEONS IN mELAUD ; LECTDBEE ON SURGERY AT THE RICHMOND HOSPITAL SCHOOL OF MEDICME; SURGEON TO THE TALBOT DISPENSARY, AND TO THE LUNATIC ASYLUM, ISLAND-BRIDGE ; SECRETARY TO THE PATHOLOGICAL SOCIETY OF DUBLIN ; FELLOW OF THE ROYAL MEDICO-CHIEURGICAL SOCIETY OP LONDON. DUBLIN: HODGES AND SMITH, aRAFTON-STREET. 1847. /'T.J^ ^ DUBLIN : PRINTED AT THE UNIVEESITY PKESS, BY M. n. GIIiLi. PREFACE. " On ne saurrait assez insister sur le diagnostic des fractures et des luxa- tions, car on rencontre a chaque instant dans les hopitaux beaucoup des cas qui ont echappe a la sagacite et a I'observation des grands maitres. C'est ainsi que les affections de I'articulation coxo-femorale, les luxations scapulo-hum^rales, les fractures de I'extremite inferieur du radius, et en general toutes les solutions de continuite au voisinage des articles, sont les sources de nombreuses erreurs." DupoYTBEN, Legons Orales, t. iii. p. 393. The object which I have had in view in submitting the following pages to the consideration of the Profession, has not been to present a systematic treatise upon the ex- tensive subject of fractures and dislocations (which the valuable work of Sir Astley Cooper renders unnecessary), but to direct attention to that most difficult portion of it—fractures in the vicinity of joints; and even here I have, for the present, limited myself to the consideration of those of which I had most experience, the differential diagnosis of which I found to be attended with the great- est difficulty, and whose anatomical characters I have had the most frequent opportunities of investigating. The elaborate researches of Breschet, Dupuytren, Bouvier, Guerin, and others, have done much towards elucidating the subject of congenital luxations ; it must still, however, be considered as being in its infancy, and, IV PREFACE. therefore, any addition to our knowledge of it cannot be deemed unimportant, the more especially as congenital and accidental luxations are frequently confounded. It has been my endeavour to make the style of the work as familiar and perspicuous as possible. Whatever deficiencies may exist in the descriptions of the various injuries alluded to, will, I trust, be found amply compen- sated for by the illustrations, for the accuracy of which I pledge myself They have, with the exception of a few copied from other works, been drawn from nature under my own immediate inspection, by that distinguished artist, Mr. Connolly, whose name is a sufficient guarantee for their fidelity. They have been, with the exception of those contained in the fourth, seventh, and eighth chap- ters, engraved by Mr. George Hanlon, whose abilities are too well known to require any eulogium upon my part. To the Publishers, Messrs. Hodges and Smith, my best thanks are due, for the readiness with which they ac- ceded to all my wishes with regard to the work. Dublin, 63, Eccles-sreet, April, 1847. CONTENTS. -- CHAPTER I. PAGE. On the Diagnosis and Pathology of Fractures of the Neck of the Femur, 1 CHAPTEE 11. On Chronic Rheumatic Arthritis OF THE Hip-joint, 113 CHAPTEE III. On Fractures of the Bones of the Fore- arm, in the vicinity of the Wrist-joint, 129 CHAPTEE IV. On Fractures of the Humerus, in the vicinity of the Shoulder- joint, 176 CHAPTEE V. On Fractures of the Acromial Extremity of the Clavicle, . 209 CHAPTEE VL On Dislocations of the Bones of the Foot, 224 CONTENTS. CHAPTER VIL PAGE. On congenital Luxations of the Wrist-joint, 238 CHAPTER VIII. On congenital Dislocations of the Shoulder, 256 CHAPTER IX. On Dislocations of the Lower Jaw, 273 CHAPTER X. Additional Observations on Fractures of the Radius, Disloca- tions of the Bones of the Foot, and congenital Luxation of the Wrist-joint, 294 ANALYTICAL INDEX. CHAPTER I. DIAGNOSIS AND PATHOLOGY OP FRACTURES OF THE NECK OF THE FEMUR. PAGE. General symptoms of fracture of the neck of the femur, 2 Appearances of limb, when the patient is supported in the erect position, . 4 Fracture without the previous occurrence of a fall upon the hip, .... 5 Diagnosis of the injury frequently very obscure, 5 Contradictory statements respecting the amount of shortening in fractures within and external to the capsule, 6 Cervical ligament of the femur—" retinacula" of Weitbrecht, .... 7 Circumstances which influence the amount of shortening of the limb, . 8 Different periods after the accident at which shortening may occur, . 11 Sudden occurrence of shortening, some time after the receipt of the injury, 12 Erroneously ascribed by Dupuytren to the yielding of the provisional callus, 13 Opinion of Rodet as to its value, as a diagnostic sign of the seat of fracture, 14 Opinion of Rodet as to amount of shortening, in each variety of fracture, 15 Extracapsular fractures accompanied by fracture of the trochanters, . 16 Causes from which the second lesion of the bone results, 17 Rodet's diagnostic sign of the seat of fracture with respect to the capsule, 20 General position of the foot in each variety of fracture, 22 Opinions entertained respecting the cause of inversion of the foot, ... 23 Mr. Guthrie's explanation inapplicable to cases of intracapsular fractures, 23 Dupuytren's opinion incorrectly stated by the editors of his lectures, . 26 Symptoms of impacted fractures of the neck of the femur, 28 Difficulties which attend the diagnosis in these cases, 29 Impacted fracture and contusion of the hip frequently confounded, ... 30 Contusion in cases of chronic rheumatic arthritis, mistaken for fracture, 31 Usual anatomical characters of intracapsular impacted fractures, ... 33 Anatomical characters of extracapsular impacted fractures, 34 Rare variety of extracapsular impacted fracture, 33 Vlll ANALYTICAL INDEX. PAGE. Osseous deposits about the trochanters in extracapsular fractures, . 36 Erroneous opinions generally entertained as to their use, 37 Object for the attainment of which they are formed, 40 Haemorrhage in cases of extracapsular fractures sometimes fatal, ... 41 Anatomical characters of fractures within the capsular ligament, ... 41 Partial fracture of the neck of the femur external to the capsular ligament, 44 Mr. Adams's opinions as to the mode of occurrence of partial fracture, . 46 Objections to the doctrine of partial fracture of the neck of the femur, . 48 Mr. CoUes's cases of partial fracture within the capsular ligament, ... 50 Question of osseous union in intracapsular fractures briefly considered, . 52 Prognosis in cases of fracture within and external to the capsule, ..
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