MIDDLE FEMORAL REGION. 247 



circumstances ; the straight portion should commence 

 just below the anterior superior spinous process of the 

 ilium, and be carried vertically over the trochanter 

 major, and the following structures divided : the gluteus 

 medius and minimus, obturator internus and gemelli, 

 obturator externus, pyriformis muscles, and the capsular 

 ligament. The head of the bone is protruded through 

 the wound by bringing the knee of the affected side 

 forcibly across the opposite thigh, with the toes everted. 

 The bone is to be divided below the level of the tro- 

 chanter major. A more scientific proceeding is to sepa- 

 rate the periosteum entire from the trochanter, leaving 

 the attachment of the muscles ; by this means they retain 

 in a great measure their proper action, and, moreover, 

 new bone is thrown out. 



SURGICAL ANATOMY OF THE MIDDLE FEMORAL 

 REGION. 



The limits of this region may be indicated superiorly 

 by a line drawn round the thigh at the fold of the nates, 

 and inferiority by one drawn round the lower portion of 

 the thigh at about an inch above the patella ; it has 

 the form of a truncated cone, with the base directed up- 

 wards. 



Surface Markings. Anteriorly, the prominences of the 

 oblique crossing of the sartorius, extending from the an- 

 terior iliac spine to the inner side of the knee, and of the 

 tensor fasciae femoris, inclosing a triangular interval, in 

 which is the commencement of the quadriceps extensor, 

 which forms two curved muscular masses, fuller inferi- 

 orly, and inclosing a small triangular interval immedi- 

 ately above the patella, corresponding to its tendon of 



