Pelves distorted by Reason of Deformity of the Lower Limbs.
The lower limbs may be altered either in their relation to the pelvis, or in their length and direction. Moreover, these lesions may be pri mary, dating from infancy, or they may be produced after the skeleton has attained to a great extent its normal development. There are two principal types, viz.: 1. Shortening in consequence of luxation of the femur. 2. Shortening where the .head of the femur remains within the cotyloid cavity, as in atrophy of the leg, rickets, fractures, club-foot, knock-knee, flexion with anchylosis, and after amputations and resections.
The Pelvis with Dislocated Femur.
This may be unilateral or bilateral. Sklillot was the first to point out .the modifications in the form of the pelvis caused by congenital luxation of the femur. He summarizes as follows: In double luxation the supe rior strait is heart-shaped, the conjugate being slightly increased. The transverse diameter of the outlet is much longer than the antero-poste rior, which is shortened, while the pubic arch is much enlarged. These changes are due to the traction of the muscles in a direction upwards and outwards. The depth of the pelvis is diminished. If the dislocation is unilateral, the deformity is confined to the corresponding side of the pelvis.
a. Unilateral Dislocation.
The pelvis is asymmetrical, the hall corresponding to the dislocated limb being less developed, its pubic portion being slightly depressed, and turned backward, the corresponding oblique diameter is sensibly short ened, as well as the sacro-pectineal distance. The sacroiliac articulation on the dislocated side is situated more posteriorly than the other, the sacrum being deviated slightly towards the affected side. The pelvis is
usually inclined on this side, and the lumbar spine presents in some in stances a slight antero-lateral convexity in this direction. The pubes present a depression a few hundredths of an inch to one side of the symphysis, in consequence of which the depth of the sub-pubic arch is lessened; the length of one horizontal ramus is much increased, while the anterior border of the iliac wing is diminished. The tuber ischii is rotated outwards, the ischio-pubic ramus being slender, flattened, elongated, and straightened, the result being marked obliquity of the pubic symphysis on the affected side, widening of the pubic arch at the expense of its depth, with increase in the sub-pubic angle. The distance between the ischial tuber d. Pelvis with Congenital Separation of the Symphysis.
Under the name " split pelvis " (bassin fendu) Litzmann describes a pel vis in which, as the result of arrested development, the two halves of the symphysis have never been united. (Figs. 87 and 88.) As this con nearly always associated with congenital cleft of the abdominal wall and Ectopion vesicce, it possesses no obstetric interest. This pelvis is characterized by increase in the transverse measurements in consequence of the sacrum being forced between the iliac bones, so that the latter are curved in such a way as to be nearly parallel. The pelvis is closed ante riorly only by fibrous tissue.
e. Pelvis obstructed by Morbid Growths.
The tumors may be osseous (exostoses), cancerous, sarcomatous, etc., which spring from the pelvic bones, or even from the adjacent organs.
Figs. 89, 90, 91 and 92 represent cases of exostosis, of osteosarcomata, of fractures, etc., and give sufficient idea of the gravity of these deform ities.