al violence and sometimes
as the result of muscular contraction; sometimes it takes place at the
upper extremity of the bone; sometimes at the lower; sometimes at the
head, when the condyles become implicated; but it is principally found
in the body or diaphysis. The fracture may be of any of the ordinary
forms, simple or compound, complete or incomplete, transverse or
oblique, etc. A case of the comminuted variety is recorded in which 85
fragments of bone were counted and removed.

The thickness of the muscular covering sometimes renders the diagnosis
difficult by interfering with the manipulation, but the crepitation test
is readily available, even when the swelling is considerable, and which
is liable to be the case as the result of the interstitial hemorrhage
which naturally follows the laceration of the blood vessels of the
region involved.

_Symptoms._--If the fracture is at the neck of the bone the muscles of
that region (the gluteal) are firmly contracted, and the leg seems to be
shortened in consequence. Locomotion is impossible. There is intense
pain and violent sweating at first. Crepitation may in some cases be
discerned by rectal examination, with one hand resting over the
coxo-femoral (hip) articulation. Fractures of the tuberosities of the
upper end of the bone, the great trochanter, may be identified by the
deformity, the swelling, the impossibility of rotation, and the dragging
of the leg in walking. Fracture of the body is always accompanied with
displacement, and as a consequence a shortening of the leg, which is
carried forward. The lameness is excessive, the foot being moved, both
when raising it from the ground and when setting it down, very timidly
and cautiously. The manipulations for the discovery of crepitation
always cause much pain. Lesions of the lower end of the bone are more
difficult to diagnosticate with certainty, though the manifestation of
pain while making heavy pressure upon the condyles will be so marked
that only crepitation will be needed to turn a suspicion into a
certainty.

_Treatment._--The question as to treatment in fractures of this
description resolves itself into the query whether any treatment can be
suggested that will avail anything practically as a curative measure;
whether, upon the hypothesis of reduction as an accomplished fact, any
permanent or efficient device as a means of retention is within the
scope of human ingenuity. If the reduction were successfully p