The Thigh. 337 



rotator muscles along with the glutei, and abducted by the 

 latter muscles. This position of the upper fragment pro- 

 duces a prominence at the upper and outer aspect of the 

 thigh, while the lower fragment is drawn upwards by the 

 adductors, the pectineus, gracilis, rectus, sartorius, biceps 

 and the other hamstring muscles ; inwards, by the adductor 

 muscles and pectineus and everted or rotated outwards by 

 the same muscles. A fracture through the middle of the 

 shaft would present displacement similar to the above, but, 

 when the break occurs immediately above the condyles, 

 then the lower end of the upper fragment is thrust for- 

 ward, against or through the fibres of the rectus muscle, 

 by the contraction of the psoas, iliacus, pectineus, adduc- 

 tor brevis and adductor longus. This upper fragment is 

 also adducted or drawn inwards by the pectineus and ad- 

 ductor muscles, which are more powerful than the abduc- 

 tor muscles, i.e., the glutei, and is rotated outwards by the 

 pectineus, the adductors, the glutei, and by the direct ex- 

 ternal rotators. The lower fragment is tilted back by the 

 action of the gastrocnemius and plantaris muscles, and 

 drawn upwards by the muscles referred to above, when 

 speaking of fracture below the lesser trochanter, viz., by 

 the adductors, the pectineus, gracilis, rectus, sartorius, 

 biceps and the other hamstring muscles. In this displace- 

 ment, it is possible for the popliteal vessels to be wounded, 

 especially the vein, by the upper end of the lower frag- 

 ment, and further, when the attempt is made to straighten 

 the limb by traction on the leg for the purpose of reducing 

 the fracture, the gastrocnemius tends to draw back the 

 lower fragment still more, hence the need of an inclined 

 plane to relax the gastrocnemius in the treatment of this 

 fracture. Some surgeons divide the tendo Achilles to 

 prevent this backward traction of the gastrocnemius. 



