408 SURGICAL APPLIED ANATOMY. [Chap. xix. 



With regard to the symptoms of a fracture 

 of the neck of the femur, the following may be 

 noticed : (a) The swelling often observed in the front 

 of the limb, just below Poupart's ligament, is due 

 either to effusion of blood into the joint, or to pro- 

 jection of the fragments against the front of the 

 capsule ; (6) the shortening is brought about by the 

 glutei, the hamstrings, the tensor vaginae femoris, the 

 rectus, sartorius, and ilio-psoas, the adductors, gracilis 

 and pectineus ; (c) the eversion, or rotation out- 

 wards of the limb, is mainly due to two causes : (1) 

 The weight of the limb, which causes it to roll 

 outwards, as is seen in persons insensible or asleep, 

 the line of gravity passing through the outer part 

 of the thigh ; (2) the fact that the compact tissue 

 on the posterior aspect of the neck is much more 

 fragile than that on the anterior aspect. Thus the 

 cervix is often more extensively fractured behind 

 than in front, or the fracture may be impacted behind 

 but not in front, and in either case the limb will tend to 

 become everted. As a third cause may be mentioned 

 the action of the ilio - psoas, the adductor and 

 pectineus muscles, and of the small rotators muscles, 

 all of which will tend to roll the femur outwards. 



3. Fracture of the base of the neck, involving 

 the great trochanter. In this lesion the head, the 

 cervix, and a part of the great trochanter, are sepa- 

 rated from the shaft and rest of the trochanter. 



4. Separation of epiphyses. There are three 

 epiphyses in the upper end of the femur, one for the 

 head, which unites between eighteen and nineteen ; 

 one for the lesser trochanter, which unites about 

 seventeen ; and one for the greater trochanter, which 

 unites about eighteen. The neck is formed by an 

 extension of ossification from the shaft. A few cases 

 are recorded where it is supposed that the caput 

 femoris was separated at the epiphyseal line by 



