. Modern surgery, general and operative. muscle. It causes severe localpain and tenderness. The patient cannot flex the hip. Ludloffs sign may bepresent. That sign consists of swelling and ecchymosis at the base of Scarpastriangle. The case is treated by flexing and immobilizing the thigh. Fractures of the shaft of the femur may affect any portion of the shaft,but especially the middle third, and may occur at any age. Fracture of theupper third is a rare accident. Allis estimates that each year in Philadelphiathere is i case of fracture of the upper third of the femur to every 100,000inhabitan
. Modern surgery, general and operative. muscle. It causes severe localpain and tenderness. The patient cannot flex the hip. Ludloffs sign may bepresent. That sign consists of swelling and ecchymosis at the base of Scarpastriangle. The case is treated by flexing and immobilizing the thigh. Fractures of the shaft of the femur may affect any portion of the shaft,but especially the middle third, and may occur at any age. Fracture of theupper third is a rare accident. Allis estimates that each year in Philadelphiathere is i case of fracture of the upper third of the femur to every 100,000inhabitants. Separation of the lower epiphysis occasionally occurs.^ Thecause of fractures in the upper third is usually indirect force; fractures in thelower third are due to direct force; and in fractures of the middle third thesetwo causes are about equally potential. Fracture from muscular action oc-casionally occurs. Oblique fracture is the usual variety. In many cases thesoft parts are badly lacerated and sometimes a great vessel is Fig. 408.—Intertrochanteric fracture. Fractures of the Shaft of the Femur 679 Symptoms.—The chief symptom in fracture of the shaft of the femur isgreat displacement, except when impaction occurs, when the break is due todirect force, or when the injury is in a child. In a child the Hne of fractureis often transverse and the periosteum may be untom. Green-stick fracturesoccur in children. As a rule, in fracture of the shaft of the femur the lowerfragment is drawn upward and the upper end of the lower fragment is foundposterior and somewhat to the inside of the lower end of the upper fragment,and the lower fragment also undergoes external rotation (the drawing up isdue to rectus and hamstrings; the passing inward is due to the adductor muscles;the rotation outward arises from the weight of the limb). If a fracture of thelower two-thirds of the shaft is produced by direct force, there is usually but
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