toms of _coccydynia_, which may call for excision.

INJURIES IN THE REGION OF THE HIP

These include the various fractures of the upper end of the femur;
dislocation and sprain of the hip-joint; and contusion of the hip.

#Surgical Anatomy.#--The strength of the hip-joint depends primarily
on its osseous elements--the rounded head of the femur filling the
deep socket of the acetabulum, to the bottom of which it is attached
through the medium of the ligamentum teres. The edge of the acetabulum
is specially strong above and behind, while at its lower margin there
is a gap, bridged over by the labrum glenoidale (cotyloid ligament).

In relation to fractures of the upper end of the femur, it is to be
borne in mind that as the antero-posterior diameter of the neck is
less than that of the shaft, and as a considerable portion of the
great trochanter lies behind the junction of the neck with the shaft,
the greater part of any strain put upon the upper end of the femur is
borne by the neck of the bone and not by the trochanter. The head and
neck of the femur are nourished chiefly by the thick, vascular
periosteum, and through certain strong fibrous bands reflected from
the attachment of the capsule--the retinacular or cervical ligaments
of Stanley. The integrity of these ligaments plays an important part
in determining union in fractures of the neck of the femur, both by
keeping the fragments in position and by maintaining the blood-supply
to the short fragment. Whether it be true or not that an alteration in
the angle of the femoral neck takes place with advancing years, it is
generally recognised that this change is of no importance in relation
to fractures in this region.

The articular capsule of the hip is of exceptional strength. It is
attached above to the entire circumference of the acetabulum, and
below to the neck of the femur in such a way that while the whole of
the anterior and inferior aspects of the neck lies within its
attachment, only the inner half of the posterior and superior aspects
is intra-capsular. The capsule is augmented by several accessory
bands, the most important of which is the _ilio-femoral or [inverted
Y]-shaped ligament_ of Bigelow, which passes from the anterior
inferior iliac spine to the anterior inter-trochanteric line, its
fasciculi being specially thick towards the upper and lower ends of
this ridge. The medial limb of this ligament limits extension of the
thigh, while the lateral