The treatment of fractures . everted whether impaction is present ornot. If the impaction is of the anterior portion of the neck,inversion will be present ; if the impaction is of the posteriorportion of the neck, eversion will be present (see Figs. 356, 357). FRACTURE OF THE HIP EXAMINATION 259 Impacted eversion can not be inverted nor can impacted inver-sion be everted without breaking up the impaction. In thesecases of marked eversion and inversion a dislocation of the hipmust be excluded if possible. Examination.—A prolonged search for crepitus and abnor-mal mobility must never be attempte
The treatment of fractures . everted whether impaction is present ornot. If the impaction is of the anterior portion of the neck,inversion will be present ; if the impaction is of the posteriorportion of the neck, eversion will be present (see Figs. 356, 357). FRACTURE OF THE HIP EXAMINATION 259 Impacted eversion can not be inverted nor can impacted inver-sion be everted without breaking up the impaction. In thesecases of marked eversion and inversion a dislocation of the hipmust be excluded if possible. Examination.—A prolonged search for crepitus and abnor-mal mobility must never be attempted. In order to avoid un-necessary movement of the hip and because inspection and gentlepalpation alone will so often decide the diagnosis, it is wise tofollow a routine examination. The history of the accident should be obtained. The pres-ence and location of pain are determined. How much is thefunctional usefulness of the leg involved ? What does inspec-tion reveal as to the local condition and the position of the limb ?. Fig. 354.— Case: Impacted fracture of the left hip. Note helpless attitude of limb; foot everted. What does palpation reveal? How do the measurements of theleg and the trochanter compare with similar measurements otthe uninjured leg? Last,—and to be avoided if a diagnosis hasbeen reached,—what does gentle manipulation show as to thepresence of crepitus in the hip ? In order to make a systematic examination all clothing, otcourse, should be removed from the patient. He then should beplaced upon a firm and even surface. A hard mattress, a table,or a comforter spread upon the floor will provide the necessaryconditions. An anesthetic is hardly ever necessary for diag-nostic purposes. If an anesthetic is employed, the hip shouldbe handled in the gentlest manner possible. All muscularspasm, which without an anesthetic protected the hip from vio-lence, is abolished ; therefore, movements of the hip are felt 260 FRACTURES OF THE FEMUR directly by the bone unp
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