. A practical treatise on fractures and dislocations. the ischium (Adams1 and Quain2)overlapping both sciatic notches; andthe highest, except perhaps in excep-tional cases, appears to be opposite theapex of the great sciatic notch, which,in the recumbent position, is directlybelow the anterior superior spine of theilium, the line uniting the two passingabout an inch above the margin of thecotyloid cavity. Fifty years ago Quaindemonstrated by autopsy the errorcontained in the name given by SirAstley Cooper to the lower form of dislocation into the sciatic notch,and formally called attention to
. A practical treatise on fractures and dislocations. the ischium (Adams1 and Quain2)overlapping both sciatic notches; andthe highest, except perhaps in excep-tional cases, appears to be opposite theapex of the great sciatic notch, which,in the recumbent position, is directlybelow the anterior superior spine of theilium, the line uniting the two passingabout an inch above the margin of thecotyloid cavity. Fifty years ago Quaindemonstrated by autopsy the errorcontained in the name given by SirAstley Cooper to the lower form of dislocation into the sciatic notch,and formally called attention to it; and a few years later Malgaigneshowed that the head of the bone was much less upon the ilium in thehigher form than was supposed, and further that in many, perhaps amajority, of the dislocations upon the dorsum ilii the femur leftthe socket at its lower posterior part and subsequently passed upward,so that in such cases the primary dislocation was i|ehiatic, and theiliac was secondary. This view has been amply confirmed. In 11 Fig. 329. Pyriform. Obt. eit. Dislocation below and then behind andabove the obturator internus. 1 Adams: Loc cit. 2 Quain: Medico-Chirurgieal Transactions, 184S, vol. xxxi. p. 337. 732 DISLOCATIONS. specimens of old dislocations which Malgaigne examined, the head ofthe femur rose in 5 only to the level of a line drawn from the anteriorsuperior spine of the ilium to the apex of the great sciatic notch, in 2it rose half a centimetre above this line, in 2 one centimetre, in 1 oneand a half centimetres, and in 1 two centimetres. There is no reasonto suppose that in old dislocations the head is at a lower level than inrecent ones, indeed it is probably somewhat higher. When the head of the femur leaves the socket at its lower part itpasses usually below the obturator internus and then rises behind it,so that this muscle is interposed between it and the acetabulum (). Or it may lie immediately beneath the obturator internus andpress it forcibly upwa
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