THE THIGH. 



5 2 9 



FRACTURES OF THE FEMUR. 



The femur is usually fractured through the neck, greater trochanter, upper 

 third of the shaft, middle of the shaft, or just above the condyles. 



Fractures of the Neck of the Femur. These are often difficult of diagnosis 

 and unsatisfactory in treatment. 



The signs peculiar to this fracture are due to the displacement of the fragments. 

 Some shortening occurs in all fractures of the femur (Fig. 538). Comparative 

 measurements to ascertain this will be of no value if the pelvis is tilted (see page 

 497). If by measurement the limb is shorter than the opposite one, then if the dis- 

 tance from the tip of the greater trochanter to the external malleolus is the same on 

 both sides, the injury must be higher up, or in the neck. 



The iliotrochanteric angle instead of being thirty degrees will be diminished or 

 lost. The tip of the greater trochanter will be above the Roser-Nelaton line. The 



FIG. 538. Intracapsular fracture of the neck of 

 the femur showing the shortening. The dotted line 

 represents the outline of the normal bone. 



FIG. 539. View of the outer surface of the 

 bones of the hip, showing Roser-Nelaton line 

 (a d) ; Bryant's triangle (a b c be being its 

 base) ; the iliotrochanteric line (a c) and iliotro- 

 chanteric angle (hoc). 



base of Bryant's triangle will be shorter on the injured side (Fig. 539). If the ex- 

 tended limb is rotated the arc described by the greater trochanter will be smaller 

 on the injured side because the shaft rotates on its axis instead of rotating in the 

 acetabulum. The trochanter of the injured side is usually not so prominent as on 

 the sound side. The iliotibial band is relaxed. 



Shortening is well demonstrated by flexing the thighs with the patient on his back : 

 the knee of the sound side will be found to be higher than that of the injured one. 



In all fractures of the thigh the foot is placed by gravity in eversion. The rise 

 of the greater trochanter, being nearer to the crest of the ilium, produces a slight 

 fulness 7n the outer portion of Scarpa's triangle which is absent on the healthy side. 



Line of P"racture. The neck is fractured in one of two places, near the head, 

 or near the trochanter. The former is intracapsular entirely, the latter partly intra- 

 capsular and partly extracapsular. As the capsule anteriorly descends as low as the 



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