. The principles and practice of surgery. edand quite diagnostic. I have not mentioned here the predisposingand exciting causes as differential signs of thesefractures, although they possess great importance,because they have already been fully considered. This enumeration of the signs of intra and extra-capsular fracture includes all that possess any realvalue; but, as will be seen, they are seldom abso-lutely conclusive. That is to say, they seldom de-termine positively whether the fracture is entirelywithin the capsule, or partly within and partly with-out ; and, indeed, it may not always b
. The principles and practice of surgery. edand quite diagnostic. I have not mentioned here the predisposingand exciting causes as differential signs of thesefractures, although they possess great importance,because they have already been fully considered. This enumeration of the signs of intra and extra-capsular fracture includes all that possess any realvalue; but, as will be seen, they are seldom abso-lutely conclusive. That is to say, they seldom de-termine positively whether the fracture is entirelywithin the capsule, or partly within and partly with-out ; and, indeed, it may not always be clear that itis not wholly without. This difficulty in the diag-nosis has always been admitted, and, as we shallsoon see, constitutes the basis of important practicalconclusions. Fortunately the differential diagnosis betweenfractures of the neck of the femur, and disloca-tions at this point, is much more precise. The signs which distinguishthese two accidents from each other will be considered in connectionwith hip-joint Fracture of Neck of the Femur. FRACTURES OF THE FEMUR. 287 To appreciate the difficulties of the diagnosis between intra and extra-capsular fractures, it will be convenient to arrange the symptoms inparallel columns. INTRA-CAPSULAR FRACTURES. 1. Occurs usually after fiftieth year,sometimes much earlier. 2. Most frequent in women. 3. Occasioned often in old age by slightaccidents. 4. Occasioned most often by a force oper-ating at or nearly at a right angle with theaxis of the neck, as by a fall upon the foot;or by the weight of the body in rising, etc. ;but in old persons it may be caused by aforce operating in the line of the axis ofthe neck, or nearly in this line, as by a fallupon the trochanter. 5. Often no immediate shortened one inch or more. 6. Shortening almost or quite certain af-ter the lapse of a few weeks; and finallymay shorten two inches or more 7. In proportion to the shortening, thetrochanter major approache
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