| Fig. 66.—Non-impacted Fracture through Base of Neck. | Fig. 67.—Fracture through Base of Neck of Femur with Impaction into the Trochanters. |
Clinical Features.—Although this fracture is commonly met with in strong adults, it may occur in the aged.
The lateral aspect of the hip shows marks of bruising, and there is severe pain and a considerable degree of shock. The limb lies helpless; there is generally marked eversion, with shortening, which, in non-impacted cases, may amount to 11/2 or 2 inches, and is evident immediately after the accident; it is due to the distal fragment being drawn up by the muscles inserted into the great trochanter and upper end of the shaft. In a limited number of cases the distal fragment lies in front of the proximal, and there is inversion of the limb.
Fig. 68.—Non-impacted Fracture through Base of Neck. Union has occurred with diminution of angle of neck—Coxa Vara.
On applying the various tests, the great trochanter is found to be displaced upwards, there is some antero-posterior broadening of the trochanteric region, and the ilio-tibial band is relaxed. On pressing the fingers into the lateral part of Scarpa's triangle, a mass consisting of the bony fragments may be felt, and is tender on pressure. Unnatural mobility with crepitus may be elicited.
In the impacted variety, the shortening seldom exceeds one inch; the eversion is less marked; there is some power of voluntary movement; and crepitus is absent. The broadening of the trochanteric region is greater, and the great trochanter is approximated to the acetabulum.
Prognosis.—The risks to life in the aged are similar to those of intra-capsular fracture. In youths and healthy adults the chief danger is that the limb may be shortened and its function thereby impaired.
As the periosteum and retinacular ligaments which transmit the blood vessels to the proximal fragments are intact, bony union is the rule. There is always, however, considerable thickening in the region of the trochanter due to displaced fragments and callus, and in a certain number of cases, even with the greatest care in treatment, there is a varying degree of shortening and eversion of the limb. In cases in which the distal fragment lies in front of the proximal there is permanent inversion.