318 DISEASES OF THE HOESE. 



sufficient to render the crepitation more distinct — a slight sensation of 

 grating, which may be perceived even through the thick coating of 

 muscle which covers the bone — and the sensation may not only be 

 felt, but to the ear of the expert may even become audible. This 

 external manifestation is, however, not always sufficient in itself, 

 and should always be associated with the rectal taxis for corrobora- 

 tion. It is true that this may fail to add to the evidence of fracture, 

 but till then the simple testimony afforded by the detection of crepita- 

 tion from the surface, though a strong confirmatory point, is scarcely 

 sufficiently absolute to establish more than a reasonable probability 

 or strong suspicion in the case. 



In addition to the fact that the rectal examination brings the ex- 

 ploring hand of the surgeon into near proximity to the desired point 

 of search, and to an accurate knowledge of the situation of parts, 

 both pro and con as respects his own views, there is another advan- 

 tage attendant upon it which is well entitled to appreciation. This is 

 the facility with which he can avail himself of the help of an assist- 

 ant, who can aid him by manipulating the implicated limb and 

 placing it in various positions, so far as the patient will permit, while 

 the surgeon himself is making explorations and studying the effect 

 from within. By this method he can hardly fail to ascertain the 

 character of the fracture and the condition of the bony ends. By 

 the rectal taxis, as if with eyes in the finger ends, he will " see " what 

 is the extent of the fracture of the ilium or of the neck of that bone ; 

 to what part of the central portion of the bone (the acetabulum) it 

 reaches; whether this is free from disease or not, and in what loca- 

 tion on the floor of the pelvis the lesion is situated. We have fre- 

 quently by this method been able to detect a fracture at the symphysis, 

 which, from its history and symptoms and an external examination, 

 could only have been guessed at. 



Yet, with all its advantages, the rectal examination is not always 

 necessary, as, for example, when the fracture is at the posterior and 

 external angle of the ischium, when by friction of the bony ends the 

 surgeon may discern the crepitation without it. 



Every variety of complication, including muscular lacerations with 

 the formation of deep abscesses and injuries to the organs of the 

 pelvic cavity, the bladder, the rectum, and the uterus, may be associ- 

 ated with fractures of the hip bone. 



Prognosis. — The prognosis of these lesions will necessarily vary 

 considerably. A fracture of the most superficial part of the bone of 

 the ilium or of the ischium, especially where there is little displace- 

 ment, will unite rapidly, leaving a comparatively sound animal often 

 quite free from subsequent lameness. But if there is much displace- 

 ment, only a ligamentous union will take place, with much deformity 

 and more or less irregularity in the gait. Other fractures may be 

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