Lectures on the American eclectic system of surgery . verepain on moving it. The limb is from oneto two inches shorter; the foot and kneeare turned out (as seen in Fig. 84), andthe heel inclines to rest on the other limbjust above and behind the malleolus. Onextending or rotating the limb crepitusmay be felt or heard. If extension bemade and the limb let go, it retracts sud-denly. There are varieties, however, to be dis-tinguished. When the whole of the boneis not detached, no contraction takes other cases the shortening does not FRACTURES OF THE THIGH. 665 occur for several hours and
Lectures on the American eclectic system of surgery . verepain on moving it. The limb is from oneto two inches shorter; the foot and kneeare turned out (as seen in Fig. 84), andthe heel inclines to rest on the other limbjust above and behind the malleolus. Onextending or rotating the limb crepitusmay be felt or heard. If extension bemade and the limb let go, it retracts sud-denly. There are varieties, however, to be dis-tinguished. When the whole of the boneis not detached, no contraction takes other cases the shortening does not FRACTURES OF THE THIGH. 665 occur for several hours and even days after the accident. Inrare instances, also, the foot turns in instead of out. Thepractical rule, observes Mr. Druitt, is that when an oldperson has fallen and is unable to walk and complains of painunder the hip, this fracture should be carefully looked for,though there may be no apparent shortening or eversion. A fracture within the capsular ligament (Fig 85) very rarelyunites by bony connection. Either a strong ligamentous sub- Fig. stance has to bind the parts together and serve instead of bone,or there is no fixed union at all. In the latter case a sort ofdouble joint is formed, the fractured surface of the headbecoming hollowed into a socket, and that of the neck roundedso as to play into it. The ligaments of the joint becomegreatly thickened and strengthened, as is also the case withthe obturator externus muscle. The limb in this case is per-manently shortened, causing halting in the step. Treatment.— Sir Astley Cooper, after giving some halfdozen different modes of management, thus concludes : Baffled in our various attempts at curing these cases, andfinding the life of the patient occasionally sacrificed under thetrials made to unite them, I should, if I sustained this acci-dent in my own person, direct that a pillow should be placedunder the limb throughout its length; that another should beoiled up under the knee, and that the limb should be thusrext
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