92 CLINICAL APPLIED ANATOMY. 



Direct violence will occasion fracture of the prominent parts 

 of the pelvic bones, the crest of the ilium and the coccyx being 

 the most frequently damaged. Falls, kicks, and blows may all 

 react upon these exposed parts. In the case of the crest of the 

 ilium not much displacement will occur, owing to the surrounding 

 muscles holding the fragments together. When the coccyx, 

 however, is broken, it is apt to be considerably displaced from 

 the lower end of the sacrum. 



The pelvic bones enclose important viscera, and when a fracture 

 is present there is a great liability for some of these organs to be 

 injured, either by the fragments themselves or by the force 

 which induces the fracture. The urethra passing beneath the 

 pubic arch is most frequently damaged. Extra - peritoneal 

 portions of the bladder are also exposed to injury, and likewise 

 the termination of the rectum. In some cases urine may be 

 extravasated through the wound of the urinary passage, or gas 

 may pass into the tissues through the laceration of the rectal wall. 



The nerves and vessels passing through the greater and lesser 

 sacro-sciatic foramina, because of their close proximity to the 

 line of fracture in the ilium or sacrum, may also be injured, 

 with resulting paralysis or extravasation of blood. 



FRACTURES OF THE LOWER EXTREMITY. 



Fractures of the Femur. Fractures about the neck of the femur 

 are much influenced by anatomical conditions. They consist of 

 two main varieties, the intra-capsular and the extra-capsular, 

 dependent upon the method of their production. 



The first of these, the intra-capsular, is as a rule due to indirect 

 violence. The neck of the femur is the upper part of a long lever, is 

 usually placed at an angle of about one hundred and twenty-five 

 degrees with the shaft in the adult, and it is questionable whether 

 this obliquity diminishes to any extent towards old age unless there 

 is actual disease of the part. Any sudden force, even if slight, 

 applied to the lower end of the lever, that is, to the foot such, 

 for instance, as catching the toes in the edge of a carpet, produces 



