When the general condition of the patient permits of it, an attempt should be made to secure bony union.
Extension is applied by one or other of the methods described for fracture of the shaft ([p. 149]), so modified as to maintain the limb in the abducted position, which ensures the most accurate apposition of the fragments (Royal Whitman). This position may be maintained by a hinged long-splint, an adaptation of Thomas' hip splint. The fragments may be fixed to one another by a long steel peg introduced through the skin over the great trochanter, and passed so as to transfix them; or they may be exposed by operation and sutured together. Albe uses a bone peg.
Fracture of the Neck of the Femur in Children.—The use of the X-rays has shown that this fracture is comparatively common in children, as a result of a fall or a forcible twist of the leg. The fracture is most frequently of the greenstick variety; when complete, it is usually impacted. There is shortening to the extent of a half or three-quarters of an inch, a slight degree of eversion, the movements of the hip are restricted, and there is some pain. The patient is often able to move about after the accident, but walks with a limp. Unless the use of the X-rays reveals the fracture, the condition is liable to be overlooked.
When the lesion is diagnosed, the deformity should be completely corrected, any impaction that exists being undone; and the limb is put up in a wide abduction splint ([p. 221]) or in a plaster-of-Paris case in the position of extreme abduction.
If the condition is not recognised and treated, it is liable to be followed by the development of coxa vara (Royal Whitman) ([Fig. 65]).
Fig. 65.—Coxa Vara following Fracture of Neck of Femur in a child.
Fracture through the Base of the Neck.—This fracture is usually produced by a fall on the great trochanter, although it is occasionally due to a fall on the feet or knees.
Although often spoken of as “extra-capsular,” the line of fracture is generally partly within and partly without the capsule. The fracture usually lies close to the junction of the neck with the shaft, and in the great majority of cases is accompanied by breaking of one or both trochanters. This is due to the neck being driven as a wedge into the trochanters, splitting them up. When the fragments remain interlocked, the fracture is of the impacted variety ([Fig. 67]).