244 SURGICAI^ ANATOMY OF 



a half inches, and slightly bent, the knee resting on the 

 opposite thigh, and the great toe upon the opposite in- 

 step, the head of the femur being felt beneath the glutei. 

 In the second form the limb is shortened for about half 

 an inch, and the thigh turned inwards and slightly flexed, 

 the ball of the great toe lying on the base of the meta- 

 carpal bone of the opposite foot, and the head of the 

 thigh bone protruding below and behind the tendon of 

 the obturator internus. In the third form, the limb is 

 lengthened for about one or two inches, the thigh is 

 flexed, and abducted and advanced in front of the oppo- 

 site one, the toes pointing downwards and forwards, and 

 the trunk flexed on account of the tension on the psoas 

 and iliacus muscle. In the fourth form the limb is 

 shortened, rotated outwards, and the head of the bone 

 felt on the pubes, just below Poupart's ligament. The 

 limb, moreover, is abducted, and the foot points directly 

 outwards. 



The action of the muscles is well marked in cases of 

 fracture, either of the neck of the femur internal to the 

 capsule, or just below the trochanter, as far as the upper 

 fragment is concerned. In the former case, which is the 

 fracture of old age, and is a result of the slightest mishap, 

 there is eversion of the limb, produced, according to some 

 authorities, by the action of the external rotators, but far 

 more likely by the weight of the foot alone, and shorten- 

 ing, which is produced by the action of the glutei, rectus, 

 and hamstrings. In the case of fracture below the tro- 

 chanters, a result of direct violence, the upper fragment 

 is pulled forwards by the psoas and iliacus, everted and 

 drawn outwards by the external rotators. There is short- 

 ening of the limb beyond the point of fracture, owing to 

 the action of the rectus in front and the hamstrings be- 



