A practical treatise on fractures and dislocations . emur is sometimes distinctly felt in its new position,especially when the limb is moved upward or downward. The trochantermajor is approximated toward the anterior superior spinous process ofthe ilium. Sir Astley Cooper remarks that this dislocation is the most difficult to detect,and Mr. Syme mentions a case in which the nature of the accident was over-looked by himself, and the thigh was not reduced until the thirteenth day ;l andsubsequently Mr. Syme has called attention to what he considers as one of themost important diagnostic marks—in
A practical treatise on fractures and dislocations . emur is sometimes distinctly felt in its new position,especially when the limb is moved upward or downward. The trochantermajor is approximated toward the anterior superior spinous process ofthe ilium. Sir Astley Cooper remarks that this dislocation is the most difficult to detect,and Mr. Syme mentions a case in which the nature of the accident was over-looked by himself, and the thigh was not reduced until the thirteenth day ;l andsubsequently Mr. Syme has called attention to what he considers as one of themost important diagnostic marks—indeed, he says it is never absent, nor is itever met with in any other injury of the hip-joint, whether dislocation, fracture,or bruise; this is an arched form of the lumbar part of the spine, which can-not be straightened so long as the thigh is straight, or on a line with the patientstrunk. When the limb is raised or bent upward upon the pelvis, the back rests 1 Amer. Journ. Med. Sci., vol. xviii. p. 242. 710 DISLOCATIONS OF THE THIGH. Fig. Dislocation upward and backward intogreat ischiatic notch. Below the ten-don, when the patient is recumbent.(Bigelow.) flat upon the bed ; but so soon as the limb is allowed to descend, the back be-comes arched as before.* This position, assumed by the back when an attempt ismade to straighten and depress the limb, is due to the action of the psoas magnusand iliacus internus. But this can hardly be regarded as absolutely diagnostic, inasmuch as this same phenomenon willbe observed in a degree, more or less, in adislocation upon the dorsum, and in mostcases of disease of the hip-joint. The in-version of the toes, immobility of the limb,and the absence of crepitus, are generallysufficient in themselves to distinguish itfrom a fracture of the neck. Dr. Squires,of Elmira, N. Y., suggests, also, that inancient cases the projection of the headof the femur may be felt by passing thefinger into the rectum or vagina. Withmy finger in the rec
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