FRACTURE OP THE FEMUR. 



45 



Fig. 6. 



motion. The arc which the trochanter, upon 

 rotation, will describe, will be of a much smal- 

 ler circle than that described by the rotation 

 of its fellow. 



Union is possible, but improbable ; on ac- 

 count of the difficulty of coaptating the frag- 

 ments, the want of provisional callus, the frac- 

 tured extremities being bathed in an increased 

 quantity of synovia, and the feeble nutrition 

 of the head of the bone through the round 

 ligament. Yet, in a young person of good 

 constitution, where the periosteum is not com- 

 pletely severed, there may be bony union. 

 Ordinarily there results a false joint, thicken- 

 ing of the capsule, partial absorption of the 

 fragments, and the patient is lame for life, 

 and requires a stick or crutch. Feeble old 

 women may die from the shock of the injury 

 or from the irritation of pain and confine- 

 ment. 



Treatment. — Extension and splints are un- 

 necessary — the limb should be supported by 

 pillows, and motion restrained. Care should 

 be taken with reference to bedsores, sloughs, &c. 



The 7ieck may be fractured partly wi'thin and partly without the 

 capsule, in which case the prospect of union is much more favour- 

 able. Or, the extremity of one fragment may be driven into the 

 cancellated structure of the other, constituting an impacted fracture ; 

 in these cases, crepitus is obscure, the displacement is slight, and 

 there is considerable power and motion of the limb, and but little 

 shortening and eversion. They are produced by great direct force, 

 and are attended with great pain, swelling and constitutional dis- 

 turbance. The treatment may be successful in many instances, 

 without the use of splints. 



The trochanter major may be fractured ; the process is drawn 

 upwards by the glutei muscles, and a space can be felt between the 

 fragments. Approximation and retention are difficult, and the union 

 generally ligamentous. The cure is to be effected by rest, position, 

 and relaxing the muscles. 



Fracture of the condyles is a serious injury, especially when 

 communicating with the joint. After the fragments are somewhat 

 consolidated by rest and position, passive motion must be established 

 to prevent anchylosis. 



Fracture of the shaft is easily recognised by shortening, crepita- 

 tion, &c. &c. The deformity is greater when it occurs in the upper 

 part, especially when just below the trochanters, the lower end of the 



4* 



