. Modern surgery, general and operative. ction, the thigh ^ Fracture in the Upper Third of the Femur Exclusive of the Neck, by Oscar H. Allis,Medical News, Nov. 21, 1891. 68o Diseases and Injuries of the Bones and Joints and leg are slightly flexed and usually everted. In some cases the leg and lowerfragment are inverted. There are shortening to the extent of 2 or 3 inches,pain on movement, preternatural mobihty, crepitus, and obvious deformity,and the ends of the fragments can be felt by the surgeon. In impaction there isalteration of the axis of the limb and some shortening. Always feel for
. Modern surgery, general and operative. ction, the thigh ^ Fracture in the Upper Third of the Femur Exclusive of the Neck, by Oscar H. Allis,Medical News, Nov. 21, 1891. 68o Diseases and Injuries of the Bones and Joints and leg are slightly flexed and usually everted. In some cases the leg and lowerfragment are inverted. There are shortening to the extent of 2 or 3 inches,pain on movement, preternatural mobihty, crepitus, and obvious deformity,and the ends of the fragments can be felt by the surgeon. In impaction there isalteration of the axis of the limb and some shortening. Always feel for the pulsebelow the fracture to learn if the artery is damaged. Treatment.—In setting and dressing a fracture of the thigh ether shouldbe given and the parts must be handled with great care to prevent a sharpend of bone from tearing the soft parts and puncturing the skin. In frac-ture of the shaft of the femur, if impaction exists, the fragments must be pulledapart, when the case should be treated exactly as is a non-impacted Fig. 410.—Dressing of fracture of the femur in the upper third with extension upon a double inclined plane (Agnew). After a fracture of the shaft of the femur some amount of permanent shorteningIS almost inevitable. In fracture of the upper third in an adult conservativetreatment is usually unsatisfactory, and there is permanent shortening fromangular union or from overlapping. In youths under fifteen a good result isobtained in over 90 per cent, of cases. Horizontal extension fails to correct thedisplacement of the upper fragment in fracture of the upper third. The doubleinclined plane will not correct the tilting of the upper fragment while shorteningexists. Agnew used a double inclined plane and corrected shortening by the use of extension in the axis of the partly flexedthigh (Fig. 410). This plan is one of themost serviceable of those usually employed,but it too fails completely to correct thedisplacement. If, notwithstanding po-sition a
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