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TWO CASES OF TRAUMATIC DISLOCATION OF THE HIP IN CHILDREN.
1093
CLINICAL AND LABORATORY NOTES legs
seen
TRAUMATIC DISLOCATION OF THE HIP IN CHILDREN. BY PHILIP
The child, were said to be doubled beneath her. within 15 minutes of the accident, was in extreme pain, the right thigh was almost fully flexed at the hip, abducted more than is normally possible, and externally rotated. The head of the femur could be felt above and anterior to the tuber ischii. A skiagram showed the head of the femur to be resting against the posterior lip of the her
TWO CASES OF
GLYNN, M.R.C.S. ENG.,
LATE HOUSE SURGEON TO THE BELGRAVE HOSPITAL FOR
CHILDREN.
FiG. 2
THESE two cases of traumatic dislocation of the hip in children were seen at one hospital within a year. In adults it is an uncommon injury forming only 2 per cent. of all dislocations, while in children the incidence is considerably less. C. C. Choyce, up to 1924, was able to collect only 59 recorded cases. The reasons for its relative rarity probably are the mobility of the joint, the strength of the surrounding ligaments and muscles, and the depth of the acetabulum, while in children the injury that would produce dislocation in an adult is more likely to bring about separation of the epiphysis of the head of the femur. The dislocation is usually due either to a weight falling on the back while the subject is in some sort of squatting position, or to a fall and landing with the leg bent under the body. The former is the usual cause of dislocation of the hip in miners, among whom the injury is probably much commoner than in the rest of the population. Whatever the cause, the course of events is the same, the Y-shaped iliofemoral ligament acting as a fulcrum, the head of the femur is forced through the weak portion of the capsule between the pubo-femoral and ischiofemoral ligaments, its ultimate position in relation to the acetabulum, either anterior or posterior, depending on whether the limb was abducted or
FIG. 1
(Case 2).
Anaesthesia was induced with open ether and reduction was very easily effected. An adventitious movement slightly extending the thigh, the head slipped back into place before any attempt at reduction had been made.
acetabular notch (Fig. 2).
This case is of interest because the head of the femur had been arrested in the first stage of dislocation and had not taken up either an anterior or
It is noteworthy that the child supporting her right knee as though fearful adducted at that something worse might happen if she let it go. the time of The case bears a striking resemblance to the subthe injury ; glenoid or luxatio erector type of dislocation occurring iff the at the shoulder-joint.
(Case 1).
posterior position.
was
The second case, seen 11 months after the accident, former, an I anterior, showed no disability as the result of the dislocation, I and if the and a skiagram of the hip was normal. The first case
latter,
a
posterior dislocation is produced.
unfortunately cannot I
be traced.
indebted to Mr. C. P. G. Wakeley and Mr. R. A. Ramsay for permission to publish these two cases. am
CASE 1.-A
aged
child, 3 11
yearss
RUPTURE OF THE URETHRA.
months,
admitted to the BelHosgrave was
pital with history
BY A. C. FISHER, M.B. OF THE KALENE HILL
BRISTOL, F.R.C.S. ENG.,
HOSPITAL,
N. RHODESIA.
a
of fallen ON August 21st, 1931, a man, aged 40, presented twisted under him. The out of bed with the right leg He gave a history of oldhimself for treatment. accident had occurred five days previously. The right leg was adducted, flexed and internally rotated, and the standing gonorrhcea. Four years ago, following a head of the femur could be felt in the gluteal region. X rays period of difficulty of micturition, he became entirely showed a sciatic type of dislocation, the head of the femur This retention was followed lying in the great sacro-sciatic notch (Fig. 1). A general unable to pass water. anaesthetic was given and reduction effected by Bigelow’s by abscess formation and a severe illness. circumduction method. On examination the man, who had walked 80 miles "
This
"
having
illustrates the trivial accident which may produce a dislocation when the muscles are the child probably having been asleep when he fell out of bed. case
relaxed,
CASE 2.-A girl, aged 7 years, had been sliding down the banisters and had fallen about 10 feet into the hall below ; 1Brit. Jour. Surg., 1924, xii., 52.
for treatment, was emaciated. The penis, scrotum, and pubes were swollen, but while the suprapubic tissues and penis pitted on pressure, the skin of the scrotum and perineal region was as hard as crocodile hide. On micturition, urine discharged itself through about a dozen sinuses above the pubes, in the penoscrotal angle, and through a perineum which was riddled with sinuses. A few drops passed the meatus,
CLINICAL AND LABORATORY NOTES legs
seen
TRAUMATIC DISLOCATION OF THE HIP IN CHILDREN. BY PHILIP
The child, were said to be doubled beneath her. within 15 minutes of the accident, was in extreme pain, the right thigh was almost fully flexed at the hip, abducted more than is normally possible, and externally rotated. The head of the femur could be felt above and anterior to the tuber ischii. A skiagram showed the head of the femur to be resting against the posterior lip of the her
TWO CASES OF
GLYNN, M.R.C.S. ENG.,
LATE HOUSE SURGEON TO THE BELGRAVE HOSPITAL FOR
CHILDREN.
FiG. 2
THESE two cases of traumatic dislocation of the hip in children were seen at one hospital within a year. In adults it is an uncommon injury forming only 2 per cent. of all dislocations, while in children the incidence is considerably less. C. C. Choyce, up to 1924, was able to collect only 59 recorded cases. The reasons for its relative rarity probably are the mobility of the joint, the strength of the surrounding ligaments and muscles, and the depth of the acetabulum, while in children the injury that would produce dislocation in an adult is more likely to bring about separation of the epiphysis of the head of the femur. The dislocation is usually due either to a weight falling on the back while the subject is in some sort of squatting position, or to a fall and landing with the leg bent under the body. The former is the usual cause of dislocation of the hip in miners, among whom the injury is probably much commoner than in the rest of the population. Whatever the cause, the course of events is the same, the Y-shaped iliofemoral ligament acting as a fulcrum, the head of the femur is forced through the weak portion of the capsule between the pubo-femoral and ischiofemoral ligaments, its ultimate position in relation to the acetabulum, either anterior or posterior, depending on whether the limb was abducted or
FIG. 1
(Case 2).
Anaesthesia was induced with open ether and reduction was very easily effected. An adventitious movement slightly extending the thigh, the head slipped back into place before any attempt at reduction had been made.
acetabular notch (Fig. 2).
This case is of interest because the head of the femur had been arrested in the first stage of dislocation and had not taken up either an anterior or
It is noteworthy that the child supporting her right knee as though fearful adducted at that something worse might happen if she let it go. the time of The case bears a striking resemblance to the subthe injury ; glenoid or luxatio erector type of dislocation occurring iff the at the shoulder-joint.
(Case 1).
posterior position.
was
The second case, seen 11 months after the accident, former, an I anterior, showed no disability as the result of the dislocation, I and if the and a skiagram of the hip was normal. The first case
latter,
a
posterior dislocation is produced.
unfortunately cannot I
be traced.
indebted to Mr. C. P. G. Wakeley and Mr. R. A. Ramsay for permission to publish these two cases. am
CASE 1.-A
aged
child, 3 11
yearss
RUPTURE OF THE URETHRA.
months,
admitted to the BelHosgrave was
pital with history
BY A. C. FISHER, M.B. OF THE KALENE HILL
BRISTOL, F.R.C.S. ENG.,
HOSPITAL,
N. RHODESIA.
a
of fallen ON August 21st, 1931, a man, aged 40, presented twisted under him. The out of bed with the right leg He gave a history of oldhimself for treatment. accident had occurred five days previously. The right leg was adducted, flexed and internally rotated, and the standing gonorrhcea. Four years ago, following a head of the femur could be felt in the gluteal region. X rays period of difficulty of micturition, he became entirely showed a sciatic type of dislocation, the head of the femur This retention was followed lying in the great sacro-sciatic notch (Fig. 1). A general unable to pass water. anaesthetic was given and reduction effected by Bigelow’s by abscess formation and a severe illness. circumduction method. On examination the man, who had walked 80 miles "
This
"
having
illustrates the trivial accident which may produce a dislocation when the muscles are the child probably having been asleep when he fell out of bed. case
relaxed,
CASE 2.-A girl, aged 7 years, had been sliding down the banisters and had fallen about 10 feet into the hall below ; 1Brit. Jour. Surg., 1924, xii., 52.
for treatment, was emaciated. The penis, scrotum, and pubes were swollen, but while the suprapubic tissues and penis pitted on pressure, the skin of the scrotum and perineal region was as hard as crocodile hide. On micturition, urine discharged itself through about a dozen sinuses above the pubes, in the penoscrotal angle, and through a perineum which was riddled with sinuses. A few drops passed the meatus,