OF THE MUSCLES OF THE LOWER EXTREMITY. 433 



Fracture of the neck of the 

 femur -internal to the capsu- 

 lar ligament (Fig. 266) is a 

 very common accident, and 

 is most frequently caused 

 by indirect violence, such 

 as slipping off the edge of 

 the kerbstone, the impetus 

 and weight of the body 

 falling upon the neck of 

 the bone. It usually oc- 

 curs in females, and sel- 

 dom under fifty years of 

 age. At this period of life, 

 the cancellous tissue of the 

 neck of the bone not un- 

 frequently is atrophied, be- 

 coming soft and infiltrated 

 with fatty matter; the com- 

 pact tissue is partially ab- 

 sorbed : hence the bone 

 is more brittle, and more 

 liable to fracture. The cha- 

 racteristic marks of this ac- 

 cident 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, Pectineus, Adductors, and Glutei 

 muscles. The shortening is produced by the action of the 

 Glutei, and by the Kectus Femoris in front, and the Biceps, 

 Semitendinosus, and Semimembranosus behind. 



Fracture of the femur just below the trochanters (Fig. 267) 

 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, in consequence of the lower frag- 

 ment being drawn upwards by the Rectus in front, and 

 the Biceps, Semimembranosus, and Semitendinosus behind ; 

 and, at the same time, everted, and the upper end thrown 

 outwards, the lower inwards, by the Pectineus and Ad- 

 ductor 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 contrac- 

 tion of the muscles, by continued extension, which may be 

 effected by means of the long splint. 



Oblique fracture of the femur immediately above the con- 

 dyle (Fig. 268) 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 posterior femoral 

 and Rectus muscles. The pointed end of the upper frag- 

 ment is drawn inwards by the Pectineus and Adductor 

 muscles, and tilted forwards by the Psoas and Iliacus, 

 piercing the Rectus muscle, and, occasionally, the integu- 

 ment. Relaxation of these muscles, and direct approxi- 

 mation of the broken fragments is effected by placing the 

 limb on a double inclined plane. The greatest care is 



28 



Fig. 266. Fracture of the Neck of the Femur within the 

 Capsular Ligament. 



Fig. 267. Fracture of the Femur 

 below the Trochanters. 



