Fractures of the Femur. 105 



3. 172. United Intracapsular Fracture of the Neck. — 



Posterior half of the upper end of a right femur, muscles 



dissected off — in spirit, showing the above. 



"An enfeebled lady, aged 77 (November 1821), in attempting to 

 walk from her bedroom to an adjoining apartment, slipped her foot 

 suddenly and unexpectedly over the ledge of a landing of a flight of 

 stairs, and immediately fell on the right hip. She attempted to rise, but 

 found that she had completely lost the power of motion in the limb of 

 that side. Her servants, on coming to her assistance, found her sitting 

 on the landing-place, her feet resting on the step below. She was 

 immediately conveyed to bed, but being in comparatively little pain, and 

 it being late in the evening, no medical assistance was required till next 

 morning. I found her in the position in which she had remained during 

 the night, resting upon her back, the right limb a little bent and 

 apparently shortened about an inch and a half, the knee and toes con- 

 siderably everted, the heel resting in the hollow between the ankle and 

 the tendo-achilles of the left leg. She made no complaint, but of inability 

 to move the leg, but all attempts to rotate the thigh occasioned consider- 

 able pain in the situation of the trochanter major, as did also the extension 

 of the limb to bring the malleoli-interni together, which was readily 

 accomplished, but retraction immediately took place, and the leg returned 

 to its original position. No crepitus could be distinguished. Judging 

 from the history and appearances of the case, fracture of the neck of the 

 femur had taken place, and her friends were apprised of the helpless state 

 to which, in all probability, she would be reduced, from no complete 

 re-union being expected. The treatment was therefore very simple. The 

 tipper part of the thigh was frequently fomented ; a broad firm bandage 

 was constantly worn from the knee along the thigh and encircling the 

 body. The limb was supported with pillows, and every attempt made to 

 keep it extended, and the heel in apposition. Under this plan, she 

 remained about five months, occasionally changing from her bed to a sofa. 

 She then began to make some partial use of the leg, and, with the assistance 

 of crutches and gently resting on the toes, she was enabled to move 

 through the room. She ultimately laid aside the crutches, and walked 

 with the assistance of a stout stick. She also, by and by, relinquished 

 the use of the stick, and with the aid of a very high-heeled shoe she was 

 enabled in the course of a year to walk with great facility through her 

 house, and for more than a twelvemonth before her last illness to descend 

 and ascend daily from one flat of her house to another to and from 

 dinner, the knee and foot continuing considerably turned out, and the 

 leg shortened upwards of an inch. In November 1823 she was seized 

 with an aff'ection of the brain, which proved fatal in April 1824." 



This would seem to have been an impacted intra-capsular 



fracture of the neck of the femur, for the following reasons, 



Vu,. 1. The injury was apparently calculated to produce 



