Chiene's test, which is simpler than either of these, consists in applying a strip of lead or tape across the front of the body at the level of the anterior superior iliac spines, and another touching the tips of the two trochanters. Any want of parallelism in these lines indicates a change in the position of one or other trochanter.
Fracture of the Upper End of the Femur
The fractures of the upper end of the femur that are liable to be confused with one another and with dislocations of the hip, include fractures of the head, the neck, the trochanters, and separation of the upper epiphyses, and fracture of the shaft just below the trochanters.
Fracture of the head of the femur is rare, and is usually a complication of backward dislocation of the hip. It takes the form of a split of the articular surface caused by impact against the edge of the acetabulum, and is analogous to the indentation fracture of the head of the humerus, which may accompany dislocation of the shoulder.
The epiphysis of the head, which lies entirely within the capsule of the joint ([Fig. 60]), is occasionally separated, and the symptoms closely simulate those of fracture of the narrow part of the neck. If the condition is overlooked or imperfectly treated, it may in course of time be followed by coxa vara.
Fig. 60.—Section through Hip-Joint to show epiphyses at upper end of femur, and their relation to the joint.
a, Epiphysis of head.
b, Epiphysis of great trochanter.
c, Epiphysis of small trochanter.
d, Capsular ligaments.
(After Poland.)
Fracture of the Neck
It has long been customary to divide fractures of the neck of the femur into two groups—“intra-” and “extra-capsular”; but as in a considerable proportion of cases the line of fracture falls partly within and partly without the capsule, this classification is wanting in accuracy. It is more correct to divide these fractures into (1) those occurring through the narrow part of the neck, which are nearly always purely intra-capsular; and (2) those occurring through the base of the neck in which the line of fracture lies inside the capsule in front, but outside of it behind.