. A practical treatise on fractures and dislocations. aration of the Apophysis. Only a few specimens, not more than a dozen, of this injury, inde-pendent of associated fracture of the neck, have been reported. Thecause appears commonly to be a blow upon the outer posterior portionof the trochanter; occasionally muscular action. The fragment usually remains attached to the femur by tendinousand periosteal fibres, and is sometimes broken into two or more pieces ;it is freely movable upon the shaft, but rarely is completely separatedfrom it and displaced upward or backward by the attached muscles
. A practical treatise on fractures and dislocations. aration of the Apophysis. Only a few specimens, not more than a dozen, of this injury, inde-pendent of associated fracture of the neck, have been reported. Thecause appears commonly to be a blow upon the outer posterior portionof the trochanter; occasionally muscular action. The fragment usually remains attached to the femur by tendinousand periosteal fibres, and is sometimes broken into two or more pieces ;it is freely movable upon the shaft, but rarely is completely separatedfrom it and displaced upward or backward by the attached reported a specimen, found in the dissecting-room, with dis-placement upward of four centimetres. Neck i demonstrated by in-cision a flat fragment on the outer aspect. The specimens of the separation of the apophysis are one in Guys 1 Bennett: British Medical Journal, October 12, 1S95. p. 893. 2 Kocher: Loc. cit., Fiss. 140 and 151-157. 3 Potherat: Bull, de la Soc. Auat., February. 1888. 4 Neck : Ceutralblatt fur Chirurgie, 1903. p. 346 FRACTURES. Hospital museum, Keys case (Fig. 204), one in Steevenss Hospital,1Dublin, Hiltons,2 Ashtons,3 Adamis,4 and The last fourare quoted from Poland. Two of these (Adamis and Steevens Hosp.)were obtained in the dissecting-room without history. In the othersdeath followed within a few weeks after the violence that was thoughtto have caused the separation, and was preceded by fever and suppura-tion about the upper part of the bone. InFig. 204. all but one (Daniels) the separation was exactly along the epiphyseal line, and thefragment was not displaced; it seems to mehighly probable that they were cases ofosteomyelitis, possibly originating in thetrauma. McCarthys case seems to me clearly tobe osteomyelitis rather than fracture. Symptoms. The symptoms are local painon pressure, and mobility of the fragment Fracture or diastasis of the great • v i •/* .1 it - • 1 ± trochanter. (Bryant.) recognizable it the sw
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