Hip bone

“ When the dislocation takes place at the hip-joint, the bone of the thigh, in this case, does not generally grow in like manner, as being the one nearest the seat of the injury, but becomes shorter than the sound one; but the growth of the bones of the leg is not arrested in like manner; nor of those of the feet, for this reason, that there is no displacement between the bones of the thigh and leg, nor between those of the leg and foot; in those cases, however, the fleshy parts of the whole limb are atrophied ”

“ If manipulation fails, and if the deformity is great and the usefulness of the limb seriously impaired, an attempt may be made to effect reduction by operation; the operation, however, is one of considerable difficulty, and in the event of failure the head of the bone should be excised. If the head has formed a new socket for itself and there is a fairly useful joint, the condition should be left alone.
Congenital dislocation of the hip is described with Deformities of the Extremities.
Sprain of the hip is comparatively rare. ”

“ Sometimes the pain is confined to the knee, and if the examination is restricted to that joint the disease at the hip may be overlooked. At this stage the attitude of the limb is not constant; at one time it may be natural, and at another slightly flexed and abducted. Tenderness of the joint may be elicited by pressing either in front or behind the head of the bone, but is of little diagnostic importance. ”

“ The injured limb cannot be moved outward and but slightly inward, yet may be bent forward. Walking is impossible. Pain and deformity of the hip joint are evident.
The only condition with which this would be likely to be confused is a fracture of bone in the region of the hip. Fracture of the hip is common in old people, but not in youth or middle adult life. In fracture there is usually not enough shortening to be perceived with the eye; the toes are more often turned out, and the patient can often bear some weight on the limb and even walk. ”

“ Adaptations of another order, in which there is a qualitative rather than a quantitative modification, arise after certain accidents to which the skeleton is liable. When the hip-joint has been dislocated, and long delay has made it impossible to restore the parts to their proper places, the head of the thigh-bone, imbedded in the surrounding muscles, becomes fixed in its new position by attachments of fibrous tissue, which afford support enough to permit a halting walk. ”

“ The three bones which form each side of the pelvis are known as the ilium, or hip bone, sometimes termed the aitch bone; secondly, the ischium, or sitz bone, being the bone by which the body is supported in a sitting position; and thirdly the pubis, which is the bone in [Pg 94] front of the acetabulum. The pubic bones meet in the middle line of the body on the under side of the pelvis in man, and on each side are partly separated from the ischia by a foramen, spoken of as the obturator foramen, which in Pterodactyles is minute and almost invisible, when it exists. ”

“ The head, which is covered with cartilage, except for an oval depression for the attachment of the ligamentum teres, one of the ligaments of the hip-joint, and which articulates with the hollow of the acetabulum in the os innominatum, projects considerably upward, inward, and forward from the shaft, the neck varying much in length and angle. It is generally more [Pg 188] horizontal in women than in men and in rickets the great weight on the softened bone tends to press the head down, causing the deformity known as “coxa vera”, in which the neck is almost horizontal. ”

“ While the hands continue upward over the sides of hips, turn them around so that the fingers point inward (Fig. 5 D) . Continue thus with the right hand on the right side until it is just above the crest of the ilium, or hip bone. The left hand, at the same time moves a little higher upward on the left side until its thumb is nearly horizontal with the nipple of the left breast. The trunk is now in an upright position, the shoulders thrown well back (Fig. 5 E) . ”

“ If a joint is left permanently stiff in an awkward and useless position, the limb may be greatly improved by excision of the joint. Thus, if the knee is left bent and the joint is excised a useful, straight limb may be obtained, somewhat shortened, and, of course, permanently stiff. If after disease of the hip-joint the thigh remains fixed in a faulty position, it may be brought down straight by dividing the bone near the upper end. A stiff shoulder or elbow may be converted into a useful, movable joint by excision of the articular ends of the bones. ”

“ Changes of the nature of chronic arthritis are liable to occur in and around the joint in old and rheumatic subjects; and atrophy or paralysis of muscles may follow, if their nerves are implicated.
Old-standing Dislocation.—It is impossible to lay down any time-limit for attempting reduction in old-standing dislocations of the hip. Manipulation may succeed in cases of some months' standing, and may fail when the bone has been out only a few weeks. In certain cases, even after reduction has been effected, there is a marked tendency to re-displacement. ”

“ The shortening is always considerable, a high-heeled shoe being required in most cases; a stick is indispensable; in many, crutches are necessary.
Various operations have been devised for the treatment of osseous anchylosis of the hip-joint when in a bad position. All are more or less dangerous. Perhaps one of the least dangerous is the plan of subcutaneous division of the neck of the femur by a narrow saw, proposed by Mr. Adams of London. It is sometimes a very laborious operation.
Excision of Knee-Joint.—Removal of Bone.—In every case the excision of the joint ought to be complete. ”

“ There the bone of the hip-joint is carried backward to the nates, and on that account it is shortened, and because the patient cannot extend it. The flesh of the whole leg is wasted in all cases, in which most, and to what extent, has been already stated. ”

“ In case the limb is turned forward from the hip, and the fetus so wedged into the passage that turning is impossible, the case is very difficult. I have repeatedly succeeded by cutting in on the hip joint and disarticulating it, then dissecting the muscles back from the upper end of the thigh bone. ”

“ The broad, unboned hip space provides for prominent hip bones. The Spirella Boning on each side of centre back, together with the elastic sections, holds the garment closely to the body in all positions with a smooth, pleasing back line. ”

“ The abdominal control, upward and backward, and the lower back control, upward and forward, unite to give a binder effect around the hips. The forward pressure on the sacrum (lower part of the spine) and backward pull over the hip bones hold with a firm grip and bring marked relief to the sacro-iliac strain. The anatomically shaped binder attachment reinforces and maintains the supporting pressure around the hips in all positions. ”

“ The other bones of the human body sometimes undergo subluxation, and sometimes complete luxation, but the articulations at the hip and the shoulder are subject only to complete luxation, more especially the hip-joint, because it has a deep and round cavity which is further strengthened by a strong brim. The limb, then, being subject to displacement from its cavity by some great violence, many differences arise according to the greater or less degree of the dislocation. ”

“ Their nates appear very prominent, from the displacement of the bones of the joint. But if in their case the bones do not sphacelate (become carious?) and if they do not become bent above the hip-joint, if nothing of this kind happen to them, they become otherwise sufficiently healthy, but the growth of all the rest of the body, with the exception of the head, is arrested. ”

“ But when we have to rely upon one sense alone, we are sometimes liable to curious deceptions. This is the case with some of the feelings of touch. In hip-joint disease the pain is often referred to the knee, while it is really in the hip. This is because the nerve which conveys sensation from the knee, also sends a branch to the hip-joint. The experiences of those who have lost a limb are familiar. ”

“ They poise the body by means of a staff on the sound side, and grasp the affected limb with the hand above the knee so as to carry the body in shifting from one place to another. If the parts below the hip-joint be used, the bones below are less atrophied, but the flesh more. ”