A text-book of clinical anatomy : for students and practitioners . rochanteric). 2. At the middle of the shaft. 3. Just above the condyles. They are generally oblique; the displacement of fragments is so great,owing to the powerful muscles on all sides, that it is necessary to applyweights to the limb in order to counteract them. In subtrochantericfractures the flexor muscles of the hip (pectineus, ileopsoas) tend to pullthe upper fragment upward and forward on account of their attachmentto the lesser trochanter. In fractures of the shaft (see Fig. 144) theglutei cause the upper fragment to be
A text-book of clinical anatomy : for students and practitioners . rochanteric). 2. At the middle of the shaft. 3. Just above the condyles. They are generally oblique; the displacement of fragments is so great,owing to the powerful muscles on all sides, that it is necessary to applyweights to the limb in order to counteract them. In subtrochantericfractures the flexor muscles of the hip (pectineus, ileopsoas) tend to pullthe upper fragment upward and forward on account of their attachmentto the lesser trochanter. In fractures of the shaft (see Fig. 144) theglutei cause the upper fragment to be abducted and the quadriceps andadductors pull the lower fragment upward and inward. Unless this isborne in mind in the treatment, and the leg abducted, there will be bothshortening, due to the overriding of fragments, and angular deformity(Fig. 144) (outward bowing). In supracondyloid fractures the two heads of the gastrocnemius,being attached to the femur just above the condyles, pull the lower frag- Crureus -Vastus externus ~ffi Sciatic nerve .Vastus externus. Biceps _-\><g» ;—Rectus and vastus internus Vein Femoral arteryInt. saphenous nerveFemoral vein Int. saphenous vein Gracilis Add. magnusSemitendinosus Fig. 146.—Section through right thigh at level of Hunters canal. Femur is seen justabove and to outer side of femoral vessels. 457 THE KNEE REGION AND KNEE-JOINT. 459 ment downward and backward. Unless the proximity (see Figs. 138 and139) of the popliteal vessels and sciatic nerve to the bone is remembered,gangrene or paralysis of the leg may result from pressure of the lowerfragment upon the structures. This can be avoided by flexing the knee(use of double inclined plane splint) in order to relax the gastrocnemiusmuscle. The femur is frequently divided below the condyles (subtrochan-teric osteotomy) to relieve deformities following injuries or diseasesof the hip-joint or neck of femur. The lower end of the shaft is also attimes operated upon (Macewens osteoto
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