Impaction occurs with considerable frequency in these cases, and, unless accompanied by too much deformity or displacement, is rather a fortunate occurrence, since by it is afforded an automatic splint which it should be the surgeon’s endeavor to not break apart. There can be no doubt, moreover, but that trifling degrees of impaction with incomplete fracture occur, especially in the aged, in many injuries to the hip. It would be the greatest misfortune to the patient in one of these cases to complete the separation, and when assured of the existence of such a lesion it is best to treat the case as though it were a fracture. I am sure that many cases which have gone into court have been due to incomplete fractures with impaction, where there has been later absorption of bone, by which the femoral neck has been much shortened, so that recognizable deformity as well as more or less disability have resulted. Other changes comprised among those already described in the chapter on Joints, under the section on Arthritis Deformans, may also occur. Callus which has been at one time abundant may also undergo too great absorption.
Fig. 310
Fig. 311
Sections of impacted extracapsular fractures of neck of femur, showing the degree of impaction and of splintering in different cases. (Erichsen.)
Extracapsular fracture of thigh.
[Fig. 311] illustrates extracapsular fracture and comminution. [Figs. 312] and [313], also from specimens in the author’s collection, show some of the changes described above, including impaction, displacement, and some osteophytic outgrowth.
Fig. 312
