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Show rascrunn or run THIGH BONE. ‘ This perpetual motion of the head of the thigh bone, is a principal cause why, being broken, it does not unite. Certainly too, there is something unfavourable in the circumstance of the neck of the bone being surrounded by the secreting and lubricating capsule of the joint, not by the 2. We next attend to the ease with which the limb is stretched. By a majority of consultants, I was induced, contrary to my own opinion, to put the apparatus on an old woman, and to endeavour to reduce what was supposed a dislocated hip; but placing my hand on the trochanter major, and pressing a finger of the same hand on the prominence of the ilium, I knew decidedly at the first motion of the assistants to pull the limb, that it was no fracture, from cellular membrane, and vascular muscles, which embrace Mow mun I W the broken ends of the bone in other fractures. The broken head and neck of the thigh bone, must be deprived of that due degree of inflammatory action of the surrounding parts which is necessary to sustain and consolidate it. But having seen the fracture of the neck of the bone, with a breaking up of the whole trochanter major, and part of the shaft of the bone, while yet there was no union by callus; I cannot attribute the defect of ossification entirely to this circumstance of the difference in the nature of the surrounding substance. The great strength of the muscles surrounding the joint, sufficiently explains that most. untoward circumstance, the shortening of the limb, in fracture of the neck of the bone. The whole strength of the muscles of the hip, of the psoae muscles, and of the muscles of the thigh, is operating inces- santly in the retraction of the cylindrical part of the bone. To counteract this dragging of the muscles, I know nothing more effectual than laying the limb on the frame which I have already described, I do not imagine that any splints about the thigh or joint, or any kind of bandaging, will be ,,_»u‘-E'* 'y} 98.4};‘n f.-r'a.< r. "a. A. i i-nxcruen or Inn amen 1505b. 110 more effectual to retain the limb in its natural position. It is particularly necessary to point out the distinctions betwixt this fracture and the dislocation of the head of the thigh bone. 1. In the first place the surgeon has to attend to the crepitation, and for this purpose he puts his hand on the joint, while the limb is moved. But it must be recollected, that the effect of mere inflammation in the joint is to change the secretion of the sinovia so much, that the cartilages move with less facility, and produce a jarring sensation, which may be mistaken for crepitation. 14-1 the ease with which the trochanter moved, and from the in« crease of the space betwixt the ilium and the trochanter. 3. In dislocation, the limb is locked as it were; but in fracture, it is easily moved, in as far as regards the surgeon, though with pain to the patient. And when the limb is moved in fracture, it is with a certain degree of elasticity; but in dislocation, by starts, and unequally. ' .p When we make an assistant take hold of the knee and ‘ancle, and bending the knee joint make the rotatory motion of the thigh bone by using the leg as a lever, we may observe the following distinctions betwixt fracture and disloca- tion :-When the heel is moved out, the head of the thigh bone checks against the back of the ilium in dislocation; whereas in fracture it has no such impediment. Again, when we make the assistant roll the thigh, while we keep the fingers on the trochanter major, we feel it, in dislocation, making a movement describing a part of a large circle ; but in fracture, it moves on the centre of the cylindrical part of the thigh bone, to which it is nearly parallel, and consequently does not escape from under the finger. See further under the head of Dislocation of the Thigh Bone. As I have said, I conceive that the frame which I have recommended, in the fractured thigh bone, will do all that it is possible to perform in the present case; it will retain the thigh bone, and the great trochanter, in their natural place and relation to the neck of the bone. But lest my reader should object to this, and think that it is better to assist the operation of this frame Work by bandaging and cplints, or A "W‘V‘WM0‘f99‘r 1: WI |