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The os innominatum may be so fractured that the pelvic girdle is broken, as in fracture of the iliac shaft, or in a manner that the girdling continuity of the innominate bones is not interrupted. It naturally follows that greater injury is done when the pelvic girdle is broken than when it is not, except in cases where the acetabulum is involved and its brim not completely divided.
The femur was six inches long, the woman had a foot of six bones, four being toes, viz., the first and second phalanges of the first and second toes. She had an acetabulum, capsule, and ligamentum teres, but no tibia or fibula; she also had a defective right forearm. She was never the victim of rachitis or like disease, but died of syphilis in the Colonial Hospital.
These four bones are the sacrum and the coccyx, which have been described, and the two hip bones. Thorax. They are united to the sacrum behind and joined to each other in front. On the outer side of each hip bone is a deep cup, or socket, called the acetabulum, resembling an ancient vinegar cup, into which fits the rounded head of the thigh bone.
The joint capsule encompasses the articulation and is attached to the brim of the acetabulum and the edge of the head of the femur. The section passes through the middle of the groove of the trochlea of the tibial tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick part of joint capsule over which deep flexor tendon plays. 4.
If the bone is rarefied, the enlarged cancellous spaces are opened into and an eroded and worm-eaten appearance is brought about; with further use of the joint, the bone is worn away, so that in a ball-and-socket joint like the hip, the head of the femur and the acetabulum are markedly altered in size and shape.
In a boy of thirteen Storrs has reported fracture of the femur within the acetabulum. In addition to the causes enumerated, inflammation of osseous tissue, or osteoid carcinoma, has been found at the seat of a spontaneous fracture. One of the most interesting subjects in the history of surgery is the gradual evolution of the rational treatment of dislocations.
It is best illustrated in arthritis deformans of the hip in which new bone formed round the rim of the acetabulum mechanically arrests the excursions of the head of the femur. The new bone, which limits the movements, is readily demonstrated in skiagrams; it may be removed by operative means.
The animal was destroyed and on autopsy the head of the femur found to be contained within a false articular cavity situated about four inches above the acetabulum. In Dr. Lusk's case as he states it, the following symptoms were presented: "Limb shortened and fixed in a position of adduction.
Here, young gentlemen, here is the place. You perceive it is very near the point of articulation with the trunk." "Yes," interposed Surgeon Wedge, rising on his toes, "yes, young gentlemen, the point of articulation with the acetabulum of the os innominatum." "Where's your Bell on Bones, Dick?" whispered one of the assistants to the student next him.
The femeropelvic articulation is formed by the hemispherical head of the femur and the acetabulum; the latter constituting a cotyloid cavity which is deepened by the cotyloid ligament. It is inserted or blends with the prepubic tendon. This ligament prevents extreme abduction of the leg.
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