American practice of surgery : a complete system of the science and art of surgery . ortening, except in cases of impaction and in trans-verse and green-stick fractures, is quite characteristic:and the swelling which is visible immediately after thefracture, before inflammation sets in, is due to shorten-ing and will be in proportion to the amount of little later, inflammatory swelling adds its portionto this deformity. Deformity, abnormal mobility, pain,tenderness, and crepitus are usually present. The short-ening is due to the contraction of the hamstring andquadriceps muscles;
American practice of surgery : a complete system of the science and art of surgery . ortening, except in cases of impaction and in trans-verse and green-stick fractures, is quite characteristic:and the swelling which is visible immediately after thefracture, before inflammation sets in, is due to shorten-ing and will be in proportion to the amount of little later, inflammatory swelling adds its portionto this deformity. Deformity, abnormal mobility, pain,tenderness, and crepitus are usually present. The short-ening is due to the contraction of the hamstring andquadriceps muscles; and the angular deformity is alsocaused by the action of these muscles. The upper frag-ment, in a fracture of the upper third, points upwardand outward, owing to the unopposed contractionof the iliacus and psoas muscles. As a rule, in fractures of the shaft ofthe femur, the lower fragment is drawn upward, and behind as well as tothe inner side of the lower end of the upper fragment. In fractures of thelower third, the gastrocnemius, when pulling upon the condyles, tilts the lower. Fig. 77.—Fracture of theShaft of the Femur, withShortening and Rotation< hitward of the Limb.(Hoffa.) FRACTURES. 179 fragment backward, causing its upper end to project toward the popliteal space,with possible injury to the great vessels of this region. Eversion of that partof the limb which is below the fracture (Fig. 77) is the rule, as in fractures ofthe neck; but there are occasional and rare exceptions in which this part of thelimb may be inverted, or may be in its usual line. The shortening, in adults,may amount to two or three inches; in children it is proportionally less. Thesharp end of a fragment may perforate the overlying tissues as the immediateresult of the exciting force, or this perforation may be caused by a fall or bythe movements of the individual subsequently to the breaking of the bone.
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Keywords: ., bookauthorbuckalbe, bookcentury1900, bookdecade1900, bookyear1906
