A practical treatise on fractures and dislocations . re depressed than theouter extremity of the neck ; in consequence of which the lower marginof its broken extremity is driven much deeper into the trochantericfragment than is the upper margin. Malgaigne believes that impaction, with consequent fracture of thetrochanters, is never absent in true extracapsular fractures, unless itbe in that very unusual variety in which the trochanter forms a partof the inner fragment (fractures through the trochanter major and baseof the neck). Robert Smith entertains the same opinion, although :nece:, withou
A practical treatise on fractures and dislocations . re depressed than theouter extremity of the neck ; in consequence of which the lower marginof its broken extremity is driven much deeper into the trochantericfragment than is the upper margin. Malgaigne believes that impaction, with consequent fracture of thetrochanters, is never absent in true extracapsular fractures, unless itbe in that very unusual variety in which the trochanter forms a partof the inner fragment (fractures through the trochanter major and baseof the neck). Robert Smith entertains the same opinion, although :nece:, without the capsule. 395 Malgaigne does not seem to have so understood him. I cannot agree,however, with either of these gentlemen that the rule is so invariable,since I am confident that no such splitting has occurred in either ofthe two specimens to which I have referred as belonging respectivelyto Drs. Mutter and Neill. It is true these are both old fractures, andto some extent the signs of fracture may have become obliterated, but Fig. 139. Fig. Impacted extracapsular fractures. (R. Smith, and Erichsen.) in Mutters specimen an abundant callus indicates plainly enoughwhere the shaft separated from the neck, while the trochanter majoris smooth as in its normal condition, nor does its summit incline eitherway from its usual position. Neills specimen, though less satisfactory,does not fail to convince me that neither impaction nor splitting of thetrochanters ever occurred. It is certain, however, that impaction and comminution of the outerfragment are very constant, and that, whether the fracture is producedby a fall upon the feet or upon the trochanter major. But the impac-tion does not necessarily continue; sometimes, indeed, it does, and theposition of the limb, whatever it may be at the moment, remains un-alterably fixed; either very little or considerably shortened, accordingto the degree of impaction ; rotated outwards or inwards, or in neitherdirection, perhaps, accordin
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectfractur, bookyear1875
