FRACTURES. 



241 



Fig. 264.— Fractures of tho Ossa Innominata : 1, at the external angle ; 2, at the 

 internal angle; 3, at the neck of the ilium; 4, at the body of the pubis; 4«, at the 

 antero-esternal angle of the ischium ; 5, at the cotyloid cavity ; 6, at the postero-exter- 

 nal angle of the ischium ; 7, at the symphysis pubis. 



opiniou and correct conclusion will depend largely upon a knowl- 

 edge of tlie history of the case, and while in some instances that 

 will be but a report of the common etiology of fractures, such as 

 blows, hurts, and other external violence, the simple fact of a fall 

 may furnish a satisfactory solution of the whole matter. 



With the exception of the deformity of the ilium in a fractiu'e 

 of its external angle, and unless there has been a serious laceration 

 of tissues and infiltration of blood, or excessive displacement, there 

 are no very definite external symptoms in a case of a fracture of 

 the hip bone. There is one, however, which, in a majority of cases, 

 will not fail — it is crepitation. This evidence is attainable by both 

 external and internal examination — by manipulation of the gluteal 

 surface and by rectal taxis. Very often a lateral motion, or bal- 

 ancing of the hinder parts by pressing the body from one side to 

 the other, will be sufficient to render the crepitation more distinct 

 — a shght sensation of grating, which may be perceived even through 

 the thick coating of muscle which covers the bone — and the sensa- 

 tion may not only be felt, but to the ear of the expert may even 

 become audible. This external manifestation is, however, not 

 always sufficient in itself, and should always be associated with the 

 rectal taxis for corroboration. It is true that this may fail to add to 

 the evidence of fracture, but till then the simple testimony afforded 



