THE HIP AND THIGH 



1435 



fibres keep the fragments together; hence one need of gentle handling; their 

 softening may explain, a little later, an increase in the shortening. 



Exploration of the joint. — This is usually effected by an oblique incision downward and 

 slightly medially between the sartorius and rectus medially and the gluteus medius and minimus 

 laterally. A branch of the ascending division of the lateral circumflex is the only artery met 

 with. In tapping the joint the puncture is made in the same line, 2 or 3 inches below the 

 anterior-superior spine. 'If the instrument is pushed upward, medially, and backward beneath 

 the rectus, it will pass into the joint a little above the anterior intertrochanteric Une. (Stiles.) 



Fig. 1153. — Region of the Hip-joint, as Shown by the R6ntgen-r.\ys. 



Trochanter major. — This valuable landmark is most prominent when the limb 

 is rotated medially or adducted; it lies at the bottom of a depression when the 

 femur is everted. 



The chief structure of importance between it and the skin is the upper part of the insertion 

 of the gluteus maximus, that going to the fascia lata, and the bm-sa beneath the muscle. This is 

 often multilocular. It is, not very uncommonly, the seat of tubercular inflammation which 

 readily invades the cancellous tissue of the trochanter. The top of the great trochanter is 

 about 1.8 cm. (| in.) below the level of the femoral head, and, when the femur is extended is a 

 little below the centre of the hip-joint. This part of the bone is covered by the gluteus medius. 



