n either of these, consists in
applying a strip of lead or tape across the front of the body at the
level of the anterior superior iliac spines, and another touching the
tips of the two trochanters. Any want of parallelism in these lines
indicates a change in the position of one or other trochanter.

FRACTURE OF THE UPPER END OF THE FEMUR

The fractures of the upper end of the femur that are liable to be
confused with one another and with dislocations of the hip, include
fractures of the head, the neck, the trochanters, and separation of
the upper epiphyses, and fracture of the shaft just below the
trochanters.

Fracture of the #head of the femur# is rare, and is usually a
complication of backward dislocation of the hip. It takes the form of
a split of the articular surface caused by impact against the edge of
the acetabulum, and is analogous to the indentation fracture of the
head of the humerus, which may accompany dislocation of the shoulder.

The #epiphysis of the head#, which lies entirely within the capsule
of the joint (Fig. 60), is occasionally separated, and the symptoms
closely simulate those of fracture of the narrow part of the neck. If
the condition is overlooked or imperfectly treated, it may in course
of time be followed by coxa vara.

[Illustration: FIG. 60.--Section through Hip-Joint to show epiphyses
at upper end of femur, and their relation to the joint.

_a_, Epiphysis of head.
_b_, Epiphysis of great trochanter.
_c_, Epiphysis of small trochanter.
_d_, Capsular ligaments.

(After Poland.)]

FRACTURE OF THE NECK

It has long been customary to divide fractures of the neck of the
femur into two groups--"intra-" and "extra-capsular"; but as in a
considerable proportion of cases the line of fracture falls partly
within and partly without the capsule, this classification is wanting
in accuracy. It is more correct to divide these fractures into (1)
those occurring _through the narrow part of the neck_, which are
nearly always purely intra-capsular; and (2) those occurring _through
the base of the neck_ in which the line of fracture lies inside the
capsule in front, but outside of it behind.

It is of considerable importance to distinguish between fractures in
these two positions. The first group occurs almost exclusively in old
persons as a result of slight forms of indirect violence, and it is
liable, on account of the feeble vascular supply to the upper
fragment, to be