. A practical treatise on fractures and dislocations. trochanter behind, it is evident that he believed consid-erable comminution to be the rule. Hamilton refers to two similarspecimens, one in Dr. Mutters, the other in Dr. Xeills collection ; inone of my own specimens there was no splintering, and in another the 1 E. W. Smith : Loc. Case 34. 326 FRACTURES. fracture was almost identical with the one quoted by Malgaigne fromSmith. The common fracture is that in which the neck is bent backwardwith crushing of the posterior part or penetration of the neckinto the trochanter. Prof. Bigelow1
. A practical treatise on fractures and dislocations. trochanter behind, it is evident that he believed consid-erable comminution to be the rule. Hamilton refers to two similarspecimens, one in Dr. Mutters, the other in Dr. Xeills collection ; inone of my own specimens there was no splintering, and in another the 1 E. W. Smith : Loc. Case 34. 326 FRACTURES. fracture was almost identical with the one quoted by Malgaigne fromSmith. The common fracture is that in which the neck is bent backwardwith crushing of the posterior part or penetration of the neckinto the trochanter. Prof. Bigelow1 directed especial attention to thisbending backward and impaction (Fig. 178) as the important featuresof the most common form of fracture in this region, the symptoms ofwhich are pain and tenderness, disability, shortening and eversion, how-ever slight, absence of crepitus, and rotation of the trochanter aboutthe head of the bone as a centre, and he described the displacement asa rotation of the head and neck backward and downward upon the Fig. Comminuted fracture at the base of the neck of the femur. portion of the anterior wall corresponding to the spiral line uniting thetrochanters as upon a hinge. This displacement accounts for the ever-sion and slight shortening. A certain amount of misapprehension has resulted from the use ofthe word impaction. Impaction, in the sense of penetration and fixa-tion, is, I think, uncommon ; while crushing, with or without penetra-tion or much splitting of the trochanter, is the rule. The penetrationor crushing may be limited to the posterior part (this, as has been said,is the most common condition), or the neck may turn upon its upperportion, making that the hinge, and sink its anterior, posterior, andlower walls into the substance of the trochanter, or the neck may be 1 Bigelow: The Hip, p. 118, and Boston Medical and Surgical Journal, 1875, vol. 1, 29. FRA(JTUIIKS 0I< THE FEMUR 327 driven bodily into the trochanter witho
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