Fracture of Femur 465 



by the long splint, nor must any attempt be made to repress the upper 

 fragment by pad or bandage, lest a sharp end work through the 



muscles, fasciae, and skin, and the fracture be rendered compound. 

 It may be dealt with, however, by keeping the patient in a slightly 

 sitting posture, so that, by flexing the trunk and pelvis on the femur, 

 the psoas and allied muscles may be relaxed to the utmost ; the knee 



Double inclined plane ; the thigh piece Fracture of upper end of femur ; limb ar- 



may be lengthened at A. ranged on double inclined plane. 



being flexed over a well-padded double inclined plane. Bending the 

 knee takes the strain off the hamstring muscles, and raises the lower 

 fragment of the femur to the level of the upper. 



Separation of the great trochanter may occur from muscular or 

 direct violence, but the fragment quickly becomes fixed again if the 

 limb be kept in absolute rest, the loose piece being steadied by a 

 bandage. The accident is apt to happen to the athlete whose femur 

 is not yet ossified throughout. 



THE HIP-JOINT 



The articular surfaces of the acetabulum and the head of the femur 

 are encrusted with a layer of permanent cartilage, which disappears 

 in chronic rheumatic arthritis. The dry surfaces of bone then become 

 worn by friction, the acetabulum becomes loose and shallow, and the 

 head of the femur flattened and worm-eaten. Or there may be a great 

 deposit of new, hard bone, which takes a beautiful polish from the 

 constant dry rubbing in the joint, so that it looks like porcelain. 



HH 



