Fracture of upper third of femur. Vicious union.
Shortening resulting from overlapping.
Overlapping fracture of femur.
Other methods of treatment of these fractures are common as well to those of the shaft, and will be considered later. These include the single and double inclined plane and the method by anterior suspension. In general the first indication is efficient traction. This should be made as efficiently as possible. When the patient cannot tolerate any of the usual methods, then the double-inclined plane may be used, the knee being hung over its apex, or anterior suspension may be practised. In severe cases patients should be simply made comfortable, with such local treatment as they can bear. It may be even necessary to place them in the semi-upright position in bed, in order to free the lungs, or to frequently change their position to avoid the formation of pressure sores.
Fig. 318
Fracture of lower end of femur, with great displacement of condyles.
Fractures of the Shaft of the Femur.
—Fractures of the shaft of the femur are usually oblique and accompanied by considerable displacement, because of the powerful thigh muscles which tend to shorten the limb. These fractures are often compound, and occasionally the femoral fragment causes serious damage to important vessels or nerve trunks. When the fracture is just below the insertion of the psoas into the lesser trochanter this muscle tends to not only pull up but to externally rotate the upper fragment. Inasmuch as there is no way of controlling this muscle or the fragment, the fractured limb should be dressed upon an inclined plane, or in anterior suspension, in such a way as to make the axis of the shaft fall into line with that of the fragment. When the fracture is in the middle of the thigh, or lower, there is sufficient length of the upper portion so that pressure can be made upon it, or that psoas activity can be overcome. [Fig. 315] illustrates the tremendous deformity that may result from neglect of these precautions. [Fig. 316] illustrates a certain degree of overlapping without conspicuous other deformity. [Fig. 317] shows the shortening which is often inevitable.
Muscle spasm should be overcome as an essential part of successful treatment, the most important feature in making traction being to use force sufficient to tire out and overcome the irritated muscles.