On intra-capsular fracture of cervix femoris with bony union, and an interesting case of urinary calculi / by Alden March.

  • March, Alden, 1795-1869.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: On intra-capsular fracture of cervix femoris with bony union, and an interesting case of urinary calculi / by Alden March. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    The neck is shortened, or altogether carried away—the head may he flattened and broad ; or it may be conical ; and in both cases greatly depressed or sunk below the highest point of the tro- chanter major, and in all instances, looking downwards and in- wards, exhibiting no angular distortion anterio-posteriorly, as is pretty generally the case in fracture of the neck of the femur. In all cases of fracture of the neck of the femur, except in im- pacted, the head of the bone looks backwards and downwards while the shaft is everted, so that when union takes place whether within or without the capsule, a convex angle presents anteriorly, and a concave angle posteriorly at the seat of the frac- ture. The following seems to be the characteristic marks by which a fracture united by bone can be distinguished from the great va- riety of abnormal changes in the condition of the head and neck of the femur, as observed in chronic rheumatic arthritis, or inter- stitial absorption at some points, and bony accumulation at others. In the latter, the head of the bone has always under- gone change of form, size and condition of surface. It may be broader and flatter in its entire circumference, or flattened at the top* or it may be pointed or conical, and some portion of it is always deprived of its cartilaginous covering. In the former, the head of the bone does not necessarily become either flatter or broader, pointed or conical, diminished in one or increased in another direction, nor even deprived of its cartilage. In arthritic subjects, who meet with fracture at an early or middle period of life, and live to old age, morbid changes may be the r* suit of chronic rheumatic arthritis, distinct from and independent of the fracture, and developed at a period quite re- mote from the occurrence of the fracture, as I shall endeavor to demonstrate in the case I am about to report. The changes produced by chronic rheumatic arthritis are pretty uniformly met with at an advanced period of life. So, too, is intra-capsular fracture almost peculiar to old age, but not • As in case No. 2, figure 4, of Prof. R. D. Mussy's recent publication of Fractures of Neck of Thigh-bone.'* See American Journal of Medical Sciences, for April, 1857/