Fracture of ilie femur. — The protection Avliich this bone receives 

 from the large mass of muscles in which it is enveloped does not 

 suffice to invest it with immunity in regard to fi-actures. It con- 

 tributes its share to the list of accidents of this description, sometimes 

 in consequence of external violence and sometimes as the result of 

 muscular contraction ; sometimes it takes place at the upper extremity 

 of the bone; sometimes at the lower; sometimes at the head, when the 

 condyles become implicated; but it is principally found in the body or 

 diaphysis. The fracture may be of any of the ordinary forms, simple 

 or compound, complete or incomplete, transverse or oblique, etc. A 

 case of the comminuted variety is recorded in which eighty-five frag- 

 ments of bone were counted and removed. 



The thickness of the muscular covering sometimes renders the 

 diagnosis difficult by interfering with the manipulation, but the crepi- 

 tation test is readily available even when the swelling is considerable 

 and which is likely to be the case as the result of the interstitial hem- 

 orrhage which naturallj' follows the laceration of the blood-vessels of 

 the region involved. If the fracture is at the neck of the bone the 

 muscles of that region '(the gluteal) are firmly contracted and the 

 leg seems to be shortened in consequence. Locomotion is impossible. 

 Crepitation may in some cases be discerned by rectal examination, 

 with one hand resting over the coxo-femoral (hip) articulation. Frac- 

 tures of the tuberosities of the upper end of the bone, the great 

 trochanter, may be identified by the deformity, the swelling, the 

 impossibility of rotation, and the dragging of the leg in walking. 

 Fracture of the body is always accompanied by displacement, and as 

 a consequence a shortening of the leg, which is carried forward. The 

 lameness is excessive, the foot being moved, both w^hen raising it 

 from the ground and vrhen setting it down, very timidly and cau- 

 tiously. The manipulations for the discovery of crepitation always 

 cause much pain. Lesions of the lower end of the bone are more 

 difficult to diagnosticate with certainty, though the manifestation of 

 pain while making heavy pressure upon the condyles will be so 

 marked that only crepitation will be needed to turn a suspicion into 

 a certainty. 



The question as to treatment in fractures of this description resolves 

 itself into tlie query whether any treatment can be suggested that 

 can avail anything practically as a curative measure, whether, upon 

 the liypothesis of reduction as an accomplished fact, any permanent 

 or efficient device as a means of retention is within the scope of human 

 ingenuity. If the i-eduction were successfully x^erformed vrould it 

 be possible to keep the parts in place by any known means at our 

 disposal? At the best the most favorable result that could be antici- 

 pated would be a reunion of the fragments, with a considerable short- 

 ening of the bone, and a helpless, limping, crippled animal to remind 

 us that for human achievement there is a "thus far, and no farther." 



