Signs of Fracture of Femur" 463 



when the patella is broken across, the leg is ndt immediately and 

 forcibly flexed, and that when the olecranon is separated the elbow is 

 not rigidly flexed? 



A sound limb does not rotate on the long axis of the femur, but 

 on an imaginary axis which ascends through the mass of the adductors 

 to the centre of the femoral head. The centre of gravity of the limb 

 is far to the outer side of this axis, because the neck of the bone is 

 fending the shaft from the pelvis and from the other thigh. It is this 

 arrangement which makes eversion the natural position of the limb, 

 as occurs when one is at rest in the supine position. When the femoral 

 neck is broken, the impediment to further eversion is absent, and the 

 limb rolls into the characteristic position. Sometimes, though very 

 rarely, fracture of the femur is followed by inversion ; this is due to 

 the violence which effected the fracture having lifted the limb into,, 

 and temporarily left it in, that position. 



Unless the line of a fracture in the shaft be transverse the lower 

 fragment is apt to be ' unhitched ' from the upper, and to be steadily 

 drawn upwards by the elastic pull of muscles, nerves, vessels, fasciae,, 

 and skin; thus shortening- is a sign of fracture. In children, how- 

 ever, in whom the plane of fracture is generally square, there is no 

 overlapping of the fragments, and therefore no shortening ; and, as 

 the neck of the femur is not directed much outwards, fracture of the 

 shaft is not characterised by eversion. 



That the shortening after fracture is not due entirely to muscular con- 

 traction is evinced by the fact 

 that the amount of shortening- 

 is apt steadily to increase for 

 some time ; if it were due to 

 muscular contraction the short- 

 ening should be immediate, 

 and to the full. If the eversion 

 were due to muscular contrac- 

 tion, how is it that it generally 

 is to its full extent directly after 

 the injury, while the shorten- 

 ing, which some attribute to the 

 same cause, is but gradual ? 



When the shaft is broken, 

 unless the surfaces are inter- 

 locked (impacted), when an 

 assistant rotates the limb, the 

 trochanter remains stationary. 

 And, if the fracture be in the 

 neck, the trochanter simply 

 rotates in its long axis ; it does not sweep in a semicircle as it does 



Intra-capsular fracture. 



when the sound limb is rotated. 

 Fracture of the neck is a 



common injury in old subjects ; the 



