acture of head of femur_; _Fracture of neck of femur_;
_Fracture below lesser trochanter_--DISLOCATION OF HIP:
_Varieties_--Sprains--Contusions--FRACTURE OF SHAFT OF FEMUR.

FRACTURE OF THE PELVIS

For descriptive as well as for practical purposes, it is useful to
divide fractures of the pelvis into those that involve the integrity
of the pelvic girdle as a whole, and those confined to individual
bones.

In all, the prognosis depends upon the severity of the visceral
lesions which so frequently complicate these injuries, rather than
upon the fractures themselves.

#Fractures implicating the pelvic girdle as a whole# usually result
from severe crushing forms of violence, such as the fall of a mass of
coal or a pile of timber, or the passage of a heavy wheel over the
pelvis. The force may act in the transverse axis of the pelvis, or in
its antero-posterior axis. The pelvic viscera may be lacerated by the
tearing asunder of the bones, or perforated by sharp fragments, or
they may be ruptured by the same violence as that causing the
fracture.

As a rule, more than one part of the pelvis is broken, the situation
of the lesions varying in different cases.

_Separation of the pubic symphysis_ may result from violence inflicted
on the fork, as in coming down forcibly on the pommel of a saddle;
from forcible abduction of the thighs; or it may happen during
child-birth. In some cases the two pubic bones at once come into
apposition again, and there is no permanent displacement, the only
evidence of the injury being localised pain in the region of the
symphysis elicited on making pressure over any part of the pelvis. In
other cases the pubic bones overlap one another, and the membranous
portion of the urethra, or the bladder wall, is liable to be torn. The
displaced bones may be palpated through the skin, or by vaginal or
rectal examination.

The _pubic portion_ of the pelvic ring is the most common seat of
fracture. The bone gives way at its weakest points--namely, through
the superior (horizontal) ramus of the pubes just in front of the
ilio-pectineal eminence, and at the lower part of the inferior
(descending) ramus (Fig. 55). The intervening fragment of bone is
isolated, and may be displaced. These fractures are frequently
bilateral, and are often associated with separation of the sacro-iliac
joint, with longitudinal fracture of the sacrum (Fig. 55), or with
other fractures of the pelvic-bones.

[Illustra