lungs, or, owing to the
difficulties of nursing, bed-sores may form and death result from
absorption of toxins. Frequently the prolonged confinement to bed, the
continuous pain, and the natural impairment of appetite wear out the
strength. In many cases the patient becomes peevish, irritable, or
mentally weak.

Osseous union is the exception in intra-capsular fracture, especially
when the periosteum and the retinacular ligaments have been completely
torn, but in sub-periosteal and in impacted fractures it sometimes
occurs. As a rule, however, the neck of the femur becomes absorbed and
disappears, the head of the bone comes to lie in contact with the base
of the trochanter, and a false joint forms (Fig. 64). Chronic changes
of the nature of arthritis deformans may occur in and around such
false joints.

[Illustration: FIG. 64.--Fracture of Narrow Part of Neck of Femur. The
neck has become absorbed, the head has not united, and a false joint
has formed.]

When osseous union fails to take place, although the patient may
eventually be able to get about, he can do so only with the aid of a
stick or crutch, and as there is marked shortening, he walks with a
decided limp. There is considerable antero-posterior thickening of
the neck of the femur, and the femoral vessels may be pushed forward
in Scarpa's triangle.

_Treatment._--In treating a fracture through the narrow part of the
neck, it is necessary to consider the age and general condition of the
patient; whether the fracture is impacted or not; and the site of the
fracture--whether in the narrow part of the neck or at its base. "The
first indication is to save life, the second to get union, and the
third to correct or diminish displacements" (Stimson).

In old and debilitated patients, bony or even firm fibrous union
seldom takes place, and it is generally advisable to get them out of
bed as speedily as possible. For the first few days the patient may be
kept on his back, the limb massaged daily, and in the interval
steadied by sand-bags; but on the first sign of respiratory or cardiac
trouble he should be propped up in bed, and as soon as possible lifted
into a chair. In all such cases care should be taken to avoid undoing
impaction.

When the general condition of the patient permits of it, an attempt
should be made to secure bony union.

_Extension_ is applied by one or other of the methods described for
fracture of the shaft (p. 149), so modified as to maint