, it may occur in the aged.

The lateral aspect of the hip shows marks of bruising, and there is
severe pain and a considerable degree of shock. The limb lies
helpless; there is generally marked eversion, with shortening, which,
in _non-impacted_ cases, may amount to 1-1/2 or 2 inches, and is
evident immediately after the accident; it is due to the distal
fragment being drawn up by the muscles inserted into the great
trochanter and upper end of the shaft. In a limited number of cases
the distal fragment lies in front of the proximal, and there is
inversion of the limb.

[Illustration: FIG. 68.--Non-impacted Fracture through Base of Neck.
Union has occurred with diminution of angle of neck--Coxa Vara.]

On applying the various tests, the great trochanter is found to be
displaced upwards, there is some antero-posterior broadening of the
trochanteric region, and the ilio-tibial band is relaxed. On pressing
the fingers into the lateral part of Scarpa's triangle, a mass
consisting of the bony fragments may be felt, and is tender on
pressure. Unnatural mobility with crepitus may be elicited.

In the _impacted variety_, the shortening seldom exceeds one inch; the
eversion is less marked; there is some power of voluntary movement;
and crepitus is absent. The broadening of the trochanteric region is
greater, and the great trochanter is approximated to the acetabulum.

_Prognosis._--The risks to life in the aged are similar to those of
intra-capsular fracture. In youths and healthy adults the chief danger
is that the limb may be shortened and its function thereby impaired.

As the periosteum and retinacular ligaments which transmit the blood
vessels to the proximal fragments are intact, bony union is the rule.
There is always, however, considerable thickening in the region of the
trochanter due to displaced fragments and callus, and in a certain
number of cases, even with the greatest care in treatment, there is a
varying degree of shortening and eversion of the limb. In cases in
which the distal fragment lies in front of the proximal there is
permanent inversion.

_Treatment._--As this fracture usually occurs in robust patients,
there is no danger from prolonged confinement to bed; and as union
without deformity can be attained in no other way, this is always
advisable. When the shortening and eversion are excessive, they should
be completely corrected under anaesthesia before the retentive
apparatus is applied, any impa