Fractures of the Feimir. 117 



3. 201. Ununited Extra-capsular Fracture of the Neck.— 



Upper end of a left femur — macerated, showing the above. 



The neck of the bone has apparently given way nearer to 

 the head than usual, but there has been the characteristic 

 splitting of the great trochanter by impaction of the neck into 

 it. Much new bone has been thrown out from the upper part 

 of the shaft behind, below, and especially in front. The 

 majority of the smaller fragments have united to one another 

 and to the main piece only by fibrous tissue. The upper 

 fragment, consisting of the head and part of the neck, has no 

 new bone formed upon it, and its broken margin is quite sharp, 

 except where it has been mechanically worn against the upper 

 part of the shaft. Above this worn part the surface of the 

 bone shows some superficial erosions, as if granulation tissue 

 had been absorbing it. The want of formative power in this 

 upper fragment is probably due to insufficient vascular supply, 

 a condition which so often leads to non-union in the intra- 

 capsular variety of fracture. See N"o. 3. 179. G. C. 098. 



3. 202. Ununited Extra-capsular Fracture of the Neck.— 



Upper end of a left femur — muscles cleaned oflF, in spirit, 

 showing the above. 



The patient survived the injury several yoars. During the 

 patient's life there was difference of opinion among several surgeons as to 

 the exact nature of the injury. The case was originally treated as one of 

 fracture of the neck, but some afterwards held that it was an unreduced 

 dislocation. Sir Charles Bell in consultation confirmed the diagnosis of 

 fracture, and this view was verified at the post-mortem examination. 



The fracture has the usual characters as to the giving way 

 of the neck and splitting of the trochanters. The fragments 

 are united by firm fibrous tissue, and the leg has been 

 considerably shortened and everted. B. C. i. 1. M. 20. 



3.203. Ununited Impacted Extra-capsular Fracture of 

 the Neck, with great Displacement. — Last three lumbar 



