Fractures of the thigh may occur at the neck of the femur, its most constricted portion, or in some portion of the shaft. Fracture of the neck is most likely to occur in old people. It has been produced in elderly persons by a very slight degree of violence, as tripping on the carpet or door-sill, making a misstep, or some other equally insignificant fall.

Fracture of the neck of the femur is generally produced by a blow or fall upon the foot, or knee, or upon the outside of the hip. Pain and swelling are present as in other fractures. There is a slight change in shape of the hips. The outer portion of the injured hip being flatter than the corresponding portion of the outer side. The foot is drawn outward, the limb is shorter, and there is loss of power to use the limb.

Fractures in the shaft of the thigh are most often the result of direct violence, as a severe blow, being run over by a wagon, a fall from a considerable height, etc. The symptoms of this form of fracture are change in the form of the limb, unnatural motion, shortening of the limb, and turning of the foot outward. In determining the length of the shortened limb, in fracture of the thigh, great care should be taken in measurement. The clothing of the patient should be removed, and he should he on a flat surface, the legs parallel with each other and in line with the body. One end of a string or tape-line should then be held at the navel while measurements are taken to the upper side of the bony prominence on the inside of each ankle.

This form of fracture should receive the attention of a careful surgeon, as even with the very best of treatment, more or less deformity will be likely to result. Various methods of treatment are recommended. When the bones are impacted, all that is required is that the patient should remain in bed and keep the limb quiet while the healing is taking place. A plaster-of-Paris bandage is very useful in these cases. When the fragments are not driven together, any one of several methods may be employed. Probably the safest of these is that known as extension, in which the patient is placed in bed and extension applied to the injured limb in such a way as to overcome the tendency to shortening, which is likely to occur in consequence of contraction of the muscles. A very convenient form of apparatus of this sort in which the weight is attached by a rope passing over the pulley to a broad band of adhesive plaster which is secured to the leg by a roller bandage. Counter extension is made by means of a strap, which passes between the thighs and is attached to the upper end of the bed-stead. Sometimes the counter extension Ls made by having a foot-board raised eight or ten inches, so that the weight of the body will counteract the tendency of the weight to draw the body back to the foot Some surgeons employ the plaster-of-Paris bandage in these cases. Others recommend very highly the double-inclined plane. Two or three months are required to effect a union in these cases, and from one-fourth of an inch to two inches or more shortening will be likely to occur in most cases.

In many cases the limb is never restored to its full usefulness, always remaining weak and lame. When the fracture is treated with the limb extended, the knee is generally found to be stiff when the dressing is removed, and this difficulty must be overcome by fomentations and daily manipulations. In cases in which more than partial recovery occurs, it is generally ten or twelve months before the patient is entirely well.