Clinical Paper: Dislocation of the femur on the os pubis, reduced after a period of nearly eight weeks

The Lancet, 2 August 1851, volume 58, number 1457, page 108

DORSET COUNTY HOSPITAL. 

Reported by F.  E.  GOLDSMITH, ESQ., M.R.C.S. 

Case of Dislocation of the Femur on the os pubis, reduced after a period of nearly eight weeks.

G. T–, aged thirty-nine, a strong, muscular man, whilst at work in his garden, March 20th, was suddenly seized with an epileptic fit, and fell down, his body swinging round on its left side; he had afterwards considerable pain and swelling of the left thigh, for which he kept his bed, and was attended by a surgeon, but unfortunately the nature of the accident was not detected until shortly before his removal to the Dorset County Hospital, seven weeks and five days subsequent to the accident.

It appears from his statement, that, when a young man, he fractured the left femur, which caused that limb to be an inch shorter than the other, and slightly everted; and as he had not worn a high-heeled shoe to compensate for that shortening, considerable obliquity of the pelvis on that side took place; these circumstances combined rendered the diagnosis somewhat obscure, and account for the dislocation being overlooked in the first instance.

May 13th.  –He was admitted this day under Mr. Tapp; on examination, the leg was found to be two inches shorter than the other, and everted, the heel of the left foot being on a line, and at a right angle with the malleolus of the right; the head of the bone was distinctly felt resting on the pubes; the limb is free from pain when at rest; pain is however produced on attempting to invert the foot or flex the thigh on the pelvis: he could only progress with the aid of crutches.  A consultation was held, and it was agreed that an attempt should be made to reduce the limb; the patient (having previously been bled, and chloroform administered) was laid on the sound side, and the pulleys applied, extension being made in a direction backwards and downwards; this was kept up for more than an hour, frequent attempts being made in the meantime to lift the bone over the pubes and edge of the acetabulum by means of a towel placed round the upper part of the thigh, but without success.  Palletta’s plan of abducting the thigh, and then suddenly violently bending it towards the belly, was tried; also, that of bringing the patient to the edge of the table, and pushing the knee suddenly and forcibly backwards, at the same time adducting the limb as strongly as possible, but without apparent effect.  Mr. Tapp then requested an assistant to endeavour to lift the head of the bone with a towel placed round the upper part of the thigh, whilst he grasped the heel of the affected limb firmly with his left hand, and with the right hand placed on the outside of the knee, endeavoured to rotate the limb inwards.  Under each attempt to rotate the leg, some of the adhesions were heard to give way.  In a short time the limb rotated inwards more freely; the pulleys were then slackened, and the thighs approximated, when it was found that the limb lay nearly straight, the foot could be inverted, and the leg more easily moved in any direction; it appeared about an inch and a half shorter than the other.  He was then put to bed, the legs being fastened together with a bandage, and fomentations applied to the hip.

May 14th.  –Complains of pain in the groin, for which leeches were applied.  He fancies he felt the bone go into its place.

l6th.  –All pain in the hip and groin has ceased.

30th.  –The leg is gaining strength; he thinks it is about the same length as before the accident, and still continues somewhat everted; he can turn it either in or out.  He left the hospital at his own request, promising to return in a month.

June 26th.  –He returned to-day much improved; has good motion of the hip-joint, and his leg is getting stronger every day.

July 24th.  –Still improving; is able to take short walks.