94 CLINICAL APPLIED ANATOMY. 



advanced years in whom the fracture usually occurs. Occasionally, 

 where the retinacula are untorn, they maintain the fragments 

 in close approximation, and may also be a source of vascular 

 supply to the proximal fragment, and thus bony union may 

 occur. 



The second or extra-capsular variety of fracture of the neck 

 of the femur is as a rule due to direct violence, usually of a 

 severe character. In this form the fracture is partly within but 

 chiefly without the capsule of the joint, the line of the fracture 

 being posteriorly outside although close to the intertrochanteric 

 crest and therefore external to the capsular fibres, whilst in front 

 it runs internal to the upper portion of the spiral line to which 

 the capsule is attached. 



The fracture is most commonly induced by a fall from a height 

 upon the great trochanter, and immediately upon the solution of 

 continuity the proximal fragment is driven into the distal and 

 becomes impacted, sometimes splitting the great trochanter. 



The shortening in these cases is much greater than in the 

 non-impacted intra-capsular fractures, and may amount to as 

 much as three inches in the adult. It is occasioned by the dis- 

 placement caused by the actual violence that induced the injury. 

 The alteration in the position of the lower fragment will bring 

 the great trochanter above its normal level. This relaxes that 

 portion of the fascia lata which lies between the iliac crest and 

 the trochanter, so that there is here a certain amount of loss of 

 resistance on the injured side. 



Much bruising about the hip-bone may be present, owing to 

 the fall rupturing blood vessels and giving rise to extravasation. 



The position of the foot, which was one of marked eversion in 

 the case of intra-capsular fractures, is in the impacted extra- 

 capsular variety in the position in which it was when impaction 

 took place, and is most commonly somewhat everted. 



The union of this variety of fracture is always by bony tissue 

 owing to the impaction, which occasions the interlocking of the 

 fragments and maintains the vascular supply. 



Fractures of the shaft. When fracture of the shaft occurs 



