462 The Femur 



forwards, the gastrocttemius helping materially in the displacement 

 in the direction which the violence of the shock had first determined. 

 But if the line of fracture be from before, downwards and backwards, 

 there is neither gravity nor muscular action to unhitch the lower frag- 

 ment, and there is, therefore, no displacement, though the heavy shaft 

 of the femur may sink towards the mattress. 



Mclntyre's splint, which is a double inclined plane hollowed out 

 for the thigh and leg, is very useful in the treatment of fracture above 



the condyles, as, the knee being slightly bent, strain is taken from the 

 gastrocnemius and popliteus. 



Signs of fracture of neck or shaft. As the lever is broken the 

 limb cannot be raised, perhaps hardly moved, by the patient, and 

 there is probably deep-seated swelling, the result of effusion from the 

 torn vessels of the bone, medulla, periosteum, and adjacent muscles. 



The weight, or natural inclination of the limb, carries it into 

 the everted position. This eversion is not due to 'the numerous 

 and strong external rotatory muscles ' (Sir A. Cooper), for it is as 

 characteristic of fracture of the middle of the shaft, that is below the 

 chief mass of those rotators, as it is of fracture of the neck. More- 

 over, though the external rotators are superior in number to the 

 internal rotators, they are not in strength. 1 The eversion persists, 

 too, during anaesthesia, when muscular action is suspended, and I 

 have seen a woman with old fracture of the neck roll the limb inwards 

 at our request. 



Fracture of left femur ; limb shortened and everted. (ERICHSEN.) 



More influence is ascribed to muscles in affecting the position of 

 a limb after fracture than is their due. They are not constantly 

 contending on opposite sides of a bone in a sort of ' tug of war,' 

 ready to pull the fragment this side or that. If so, how is it that, 



1 British Medical Journal, Nov. i, 1879. 



