A system of surgery . acetabulum, and has passed back-wards and downwards to the tuberischii. In all these cases the headof the bone can be felt by manipu-lation under anaesthetics. There isconsiderable shortening, and in thedislocation downwards and back-wards, much flexion of the thighacross the middle of the thigh ofthe sound side. In the supra-spinous, and even in some appa-rently ordinary dorsal dislocations,eversion sometimes occurs, and thecase thus much resembles a has been attributed to acontinuation of the force violently rotating the limb outwardsafter the head of
A system of surgery . acetabulum, and has passed back-wards and downwards to the tuberischii. In all these cases the headof the bone can be felt by manipu-lation under anaesthetics. There isconsiderable shortening, and in thedislocation downwards and back-wards, much flexion of the thighacross the middle of the thigh ofthe sound side. In the supra-spinous, and even in some appa-rently ordinary dorsal dislocations,eversion sometimes occurs, and thecase thus much resembles a has been attributed to acontinuation of the force violently rotating the limb outwardsafter the head of the bone has reached the dorsum and rupturingsome of the fibres of the ilio-femoral ligament, upon the tensionof which inversion depends. These cases are to be diagnosedfrom fracture by the absence of crepitus, the sunken positionof the trochanter, the impossibility of bringing the limb to itsproper length by traction, and the detection of the head of thefemur in an abnormal position. In the treatment, the head of the. Fig. 409. —Obturator Dislocation of theHip. (After Pick.) DISLOCATIONS OF THE HIP. 1003 bone should be brought as close to the acetabulum as possible byflexion and traction, and then the ordinary manipulation methodsshould be applied. 3. Dislocation downwards and forwards into the obtu-rator foramen (Figs. 409 and 410). Condition of soft parts.— Thecapsule is torn inferiorly, and the rent extends forwards and upwards,instead of backwards and upwards,as in the case of the posterior dislo-cations. The ligamentum teres istorn away from the femur. Theadductors, pectineus, and gracilisfrom the abduction of the femur areexcessively tense and often ilio-psoas tendon is exceedinglytense ; the glutei and obturator in-ternus, with the gemelli and pyri-formis, are much stretched. Thehead of the bone lies on the obtu-rator externus muscle, pressing upon,tearing or stretching the obturatornerve. Causation. —This is essentiallythe accident of extreme abduct
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