364 



HUMAN ANATOMY. 



Fig. 3S1. 



Showing elevation of tip of trochanter and shortening of 

 baoc of Bryant's triangle in fracture of neck of femur; a, base 

 on sound side; b, on fractured side. 



entirely below the line of capsular attachment both in front and behind, it cannot be 

 a fracture of the neck, as it would then be below the anterior intertrochanteric line, 

 and would involve the extreme upper end of the shaft. Posteriorly, it is possible 



for a partial fracture of the neck to 

 be extracapsular, as the insertion of 

 the capsule is from twelve to seven- 

 teen millimetres (one-half to two- 

 thirds of an inch) above the base 

 of the neck. Impaction of fracture 

 at the narrow part of the neck is not 

 very common. When it occurs, 

 some spicula of the compact cortex 

 of the neck are driven into the ex- 

 panded cancellated structure of the 

 head. 



Impaction of fracture at the base 

 is common, because the spongy tro- 

 chanter is easily thrust upon and 

 sometimes split by the small and 

 relatively compact cervix. 



In most fractures of the neck 

 there will be found : 



(i) Eversion, due chiefly to (a) 

 the weight of the limb, which tends normally to roll outward ; but also to a certain 

 extent to {b) the action of the ilio- psoas and other external rotators ; (<:) the greater 

 comminution or crushing of the posterior wall of the neck, which is weaker than the 

 anterior wall. 



(2) A fulness over the upper portion of Scarpa's triangle, due to effusion into 

 the hip-joint or to forward projection of the fragments against the front of the 

 capsule. This is likely to occur because the neck is normally convex forward, the 

 lesser trochanter, marking the inner and lower boundary of the neck, being on a 

 plane posterior to the head ; and because 

 of the greater destruction of the posterior 

 portion of the neck. 



(3) Relaxation of the ilio-tibial band 

 of the fascia lata (page 367). 



(4) Approximation of the trochanter 

 to (a) the anterior superior spine, as shown 

 by shortening, best determined by the 

 length of the horizontal side or base of the 

 ilio-femoral triangle ; and to {b) the mid- 

 line of the body, as shown by Morris's line. 

 N^laton's line shows the former, but in- 

 volves more disturbance of the patient. 

 Chiene demonstrates shortening by placing 

 the edge of a straight flexible piece of metal 

 on the two anterior spines and that of an- 

 other on the tips of the two trochanters. 

 Parallelism negatives the idea of fracture. 

 Morris measures from the symphysis pubis 

 to the external trochanteric surfaces. The 



distance is lessened on the side of fracture. , Morris's measurements to show the trochanter 



_,, . Mil 1 °' ^"^ injured side nearer the median line in fracture 



1 hese pomts can easily be understood of neck of femur. 

 by reference to Figs. 381 and 382. 



Emphasis is placed on these measurements because it is perhaps more important 

 in this than in any other fracture to avoid \'igorous efforts to elicit crepitus. 



The blood-supply of the proximal fragment — the head — will reach it only 

 through the reflected portions of the capsule, untorn strips of periosteum, and the 

 ligamentum teres, that through the cervix being cut off. It is, therefore, scanty and 



