Dislocation of the Thigh Downwards

Edwin Gurney
1845 Boston Medical and Surgical Journal  
a miner, aged 45, a short, but muscular man, on TuesdayĴ an. 7th, in assisting to load some large one-and-a-half-inch deal board-, fell backwards, and in falling,two boards fell across the upper part of hi« hips. On rising, he found he had injured his left hip-joint ; although in considerable pain, be could walk. Ho was carried on a railway carriage U) within two hundred yards of his home, to which he walked. The surgeons of the mine, on seeing him, at first considered it to be a dislocation in
more » ... be a dislocation in the obturator foramen ; but from the usual symptoms being wanting, and his being able to walk, they concluded there was no dislocation. On Wednesday, the 15th, on passing the door, 1 was called in, and on examination, pronounced the thigh to be dislocated. 1 found that he could walk about, but lame, and in pain. 1 believe be walked to the mine two days previously, a distance of a mile. The affected limb was more than one inch longer than the other; the toe was slightly everted, and could be turned in or out readily, but the latter more so than the opposite foot ; there was considerable swelling of the buttock, and considerable effusion over the trochanter major. On sitting, his left knee projected considerably, and flexion on ihe pelvis beyond the silting posture caused great pain, and could not be, borne, while the other knee could be approximated to the mouth easily. On standing on the injured limb, the opposite heel could not be brought to touch the ground by more than an inch ; and when standing on the sound limb, the injured one was bent at the knee. The trochanter major was at more 'than an inch greater distance from the crista of the ilium, and projecting more, both forwards and laterally, than on the sound side ; and I considered I could feel the head of the bone by pressing behind the trochanter, and a little above it, which gave him violent pain. Mr. S. Cooper describes, in his Dictionary, " a primary dislocation of the thigh downwards and backwards on the junction of the ilium and ischium," which be states to be " as rare as the dislocation upwards and backwards, with the head of the bone forwards, and the toes everted, with shortening of the limb." But in this dislocation, when sitting, and the knees approximated, the injured limb was considerably longer than the other, consequently the head of the lione must have been immediately under the acetabulum, and in flexion of the thigh, inclined forwards, and not behind it. 1 called on the medical men, stating my opinion, and we went together to see the patient ; l>ut they still were sceptical as to its being a dislocation, but acknowledged that the joint was not right. 1 wished them to call in another surgeon, if they doubled the dislocation, remarking, that the limb, if properly extended, they would find would be made shorter. They then agreed to make an extension, which was done for some minutes, with three attempts at reduction. On the third attempt, F. R-exclaimed, he neither could nor would bear any more ; he was sure it was all right.
doi:10.1056/nejm184505280321702 fatcat:ny6f5mdlqzdtnn5wqebbgumoa4