A practical treatise on fractures and dislocations . d was separated from thepelvic bones only by the obturator internusand the gemelli. The pyramidalis, situatedabove the head of the femur, was moderatelystretched. The gemelli and obturator internuswere greatly stretched; which last-mentionedmuscles, with the capsular ligament, aloneseparated the head from the cotyloid cavity,and from the surface of the innominatumsituated behind this cavity. The externalobturator and the quadratus were torn trans-versely. The capsule was detached from thecotyloid margin at its inferior and internalinsertions
A practical treatise on fractures and dislocations . d was separated from thepelvic bones only by the obturator internusand the gemelli. The pyramidalis, situatedabove the head of the femur, was moderatelystretched. The gemelli and obturator internuswere greatly stretched; which last-mentionedmuscles, with the capsular ligament, aloneseparated the head from the cotyloid cavity,and from the surface of the innominatumsituated behind this cavity. The externalobturator and the quadratus were torn trans-versely. The capsule was detached from thecotyloid margin at its inferior and internalinsertions, while its posterior and externalportions were intact. The round ligamentwas torn from its insertion into the head ofthe femur. In a case reported by Scott,2 the sciaticnerve was compressed between the head andthe ischium. Symptoms.—The position of the limbis in some cases nearly the same as incertain dislocations upon the dorsum. Itis shortened usually about half an inch,the thigh being flexed upon the body,adducted, and rotated inward; but the. Showing tense condition of ante-rior half of capsular ligament inbackward dislocation. (Gunn.) i Quain, Poinsot, op. cit., p. 1054. 2 Scott, Dublin Hosp. Eep., 1S22, vol. 3, p. 389. UPWARD AND BACKWARD INTO ISCHIATIC NOTCH. 709 flexion is often less than in dislocations upon the dorsum, while, on theother hand, it is sometimes much greater. Generally it is such that,when the patient is standing, the end of the great toe of the dislocatedlimb touches the ball of the great toe of the sound limb. Bigelow observes that the extreme flexion which is sometimes found to existespecially when the patient is in the recumbent position, is generally due to thearrest of the head of the femur by the internal obturator and the subjacent un-torn capsule. When the patient rises, the weight of the limb may force thehead up behind the tendon of the obturator; or if the limb is brought down Fir. 457
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