Civil War Washington

CASE 971.—Fracture of the femur caused by a fall from a bridge.—Private F. Buob, Co. C, 108th Ohio, aged 36 years, was admitted to the Government Hospital for the Insane near Washington on May 16, 1865, his condition being described by the superintendent, Dr. C. H. Nichols, as follows: "The patient's mental condition was that of slight chronic dementia. He was not able to walk up stairs to the ward on account of a lameness of the left hip, the sergeant in charge of him stating that this was caused by a fall from a bridge, which had occurred between two and three weeks previous to his admission. His own statement was that in marching across the bridge at night he was accidentally crowded off the side and fell down some distance, striking upon his left hip. As he laid upon his back the injured limb appeared shortened and the toes, turned toward the other foot. By measurement the shortening was found to be three-fourths of an inch. The trochanter was flattened and approximated to the anterior superior spinous process of the ilium. On rotating the limb no point of false motion was discovered and no crepitation. The arc of the movement of the trochanter was less than that of the sound side. When the patient stood erect there was the same shortening and the same inversion of the foot. He could limp about a little by the aid of a chair, bearing considerable of his weight upon the injured limb. The diagnosis of the case was that of an impacted fracture of the neck of the femur. The limb improved rapidly, and in a few weeks the patient walked without inconvenience excepting what arose from the shortening. The general appearance of the man, however, led to the suspicion of pulmonary tuberculosis, and a physical examination of the chest confirmed this suspicion. The tuberculosis advanced with the ordinary phenomena of cough, expectoration, some hemoptysis, and occasional pleuritic and pneumonic inflammation. From this disease the patient died January 28, 1866. The post-mortem examination of the body proved the correctness of the diagnosis respecting the lung disease. Nothing peculiar was noticed about the acetabulum of the injured side except that the ligamentum teres and the cushion of fat at the bottom were more vascular than on the sound side. The femur presented unmistakable evidence that the injury was an impacted fracture of the neck of the bone, the line of it being partly within and partly without the capsular ligament. By comparison with the sound femur a shortening of three-fourths of an inch was shown, and the impaction was found to be greater anteriorly than posteriorly, thus causing the inversion of the foot. The union of the bone appeared to be firm and sound." Both the injured and the sound femur were contributed to the Museum by the reporter of the case and constitute specimen 2376 of the Surgical Section.