Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
An abscess may appear _in the thigh_ in front or behind the joint. The
_anterior abscess_ emerges on one or other side of the psoas muscle;
from the resistance offered by the fascia lata, the pus may gravitate
down the thigh before perforating the fascia. It has occasionally
happened that when such an abscess has been opened and become infected
with pyogenic organisms, the femoral vessels have been eroded, and
serious or even fatal hæmorrhage has resulted. The _posterior abscess_
appears in the buttock and may make its way to the surface through the
gluteus maximus; more often it points at the lower border of this
muscle in the region of the great trochanter, or it may gravitate down
the thigh.
Abscesses which form _within the pelvis_ originate either in
connection with the acetabulum or in relation to the psoas muscle
where it passes in front of the joint. Those that are directly
connected with disease of the acetabulum may remain localised to the
lateral wall of the pelvis, or may spread backwards towards the hollow
of the sacrum. They may open into the bladder or rectum, or may ascend
into the iliac fossa and point above Poupart's ligament (Fig. 115), or
descend towards the ischio-rectal fossa. The abscess which develops in
relation to the psoas muscle may be shaped like an hour-glass, one sac
occupying the iliac fossa, the other filling up Scarpa's triangle, the
two sacs communicating with each other through a narrow neck beneath
Poupart's ligament.
So long as the skin is intact, the abscess is unattended with
symptoms, and may escape notice. If it bursts externally, pyogenic
infection is almost inevitable, and the patient gradually passes into
the condition of hectic fever or chronic toxæmia; he loses ground from
day to day, may become the subject of waxy disease in the viscera, or
may die of exhaustion, tuberculous meningitis, or general
tuberculosis.
#Dislocation# is a rare complication of hip disease, and is most
likely to occur during the stage of adduction with inversion. It has
been known to take place during sleep, apparently from spasmodic
contraction of muscles. In the dorsal dislocation, which is the most
common form, adduction and inversion are exaggerated, the trochanter
projects above and behind Nélaton's line, and the head of the bone may
be felt on the dorsum ilii. It is a striking fact that after
dislocation has occurred there is less complaint of pain or of
startings than before, and passive movements may be carried out which
were previously impossible.
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