OF THE MUSCLES OF THE LOWER EXTREMITY. 355 



Fracture of the neck of 

 the femur within the cap- 

 sular ligament (fig. 199) 

 is a very common accident, 

 and is most frequently 

 caused by indirect vio- 

 lence, such as slipping off 

 the edge of the curbstone, 

 the impetus and weight 

 of the body falling upon 

 the neck of the bone. It 

 usually occurs in females, 

 and seldom under fifty 

 years of age. At this 

 period of life, the cancel- 

 lous tissue of the neck of 

 the bone not unfrequently 

 is atrophied, becoming soft 

 and infiltrated with fatty 

 matter, and the compact tis- 

 sue is partially absorbed ; 

 hence the bone is more 

 brittle, and more liable to 

 fracture. The characteris- 

 tic marks of this accident 

 are slight shortening of the 

 limb, and eversion of 

 the foot, neither of which 

 symptoms occur, however, 

 in some cases until some 

 time after the injury. The 

 eversion is caused by the combined action of the external 

 rotator muscles, as well as by the Psoas and Iliacus, Pec- 

 tineos, Adductors, and Glutei muscles. The shortening 

 and retraction is produced by the action of the Glutei, and 

 by the Rectus femoris in front, and the Biceps, Semi-tendi- 

 nosus, and Semi-membranosus behind. 



Fracture of \h& femur just below the trochanters (fig. 200) 

 is an accident of not unfrequent occurrence, and is at- 

 tended with great displacement producing considerable 

 deformity. The upper fragment, the portion chiefly dis- 

 placed, is tilted forwards almost at right angles with the 

 pelvis, by the combined action of the Psoas and Iliacus ; 

 and, at the same time, everted and drawn outwards by the 

 external rotator and Glutei muscles, causing a marked 

 prominence at the upper and outer side of the thigh, and 

 much pain from the bruising and laceration of the muscles. 

 The limb is shortened, from the lower fragment being 

 drawn upwards by the Rectus in front, and the Biceps, 

 Semi-inembranosus, and Semi-tendinosus behind ; and, at 

 the same time, everted, and the upper end thrown out- 

 wards, the lower inwards, by the Pectineus and Adductor 

 muscles. This fracture may be reduced in two different 

 methods; either by direct relaxation of all the opposing 

 muscles, to effect which, the limb should be placed on a 

 double inclined plane ; or, by overcoming the contraction 

 of the muscle by continued extension, which may be 

 effected by means of the long splint. 



Oblique fracture of the femur immediately above the con- 

 dyles (fig. 201) is a formidable injury, and attended with 

 considerable displacement. On examination of the limb, 

 the lower fragment may be felt deep in the popliteal 

 space, being drawn backwards by the Gastrocnemius, 

 Soleus, and Plantaris muscles ; and upwards by the poste- 

 rior femoral, and Rectus muscles. The pointed end of the 

 upper fragment is drawn inwards by the Pectineus and 

 Adductor muscles, and tilted forwards by the Psoas and 

 Iliacus, piercing the Rectus muscle, and, occasionally, the 

 integument, Relaxation of these muscles and direct 

 approximation of the broken fragments are effected by 

 placing the limb on a double inclined plane. The greatest 



Fig. 199. Fracture of the Neck of the Femur within the 

 Capsular Ligament. 



Fig. 200. Fracture of the Femur 

 below the Trochanters. 



