ction that exists being undone. When the
deformity resulting from impaction is slight, however, it is best to
leave it, as it facilitates speedy and firm union.

Extension is obtained by the same appliances as are used in fracture
of the shaft, and the limb should be kept in the abducted position.

Fracture of the #greater trochanter# occurring apart from fracture of
the neck usually results from direct violence, but may be due to
muscular action. The trochanter is displaced by the gluteal muscles,
causing broadening of the lateral aspect of the hip. In young persons
the _epiphysis_ of the great trochanter may be separated, but this is
rare. The treatment consists in retaining the fragments in position by
keeping the limb abducted between sand-bags, or by pegs driven in
through the skin.

#Fracture immediately below the lesser trochanter# may be produced by
direct or by indirect violence, and the displacement depends largely
on whether the line of fracture is transverse or oblique. The proximal
fragment is kept tilted forward, rotated laterally, and abducted by
the ilio-psoas muscle and the lateral rotators inserted in the region
of the great trochanter. The lower fragment passes upward, and is
rotated laterally by the weight of the limb; the displacement is
aggravated by the contraction of the flexor and adductor muscles. The
tilting of the proximal fragment may be increased by the displaced
distal fragment pushing it forward.

On account of the difficulty of controlling the short proximal
fragment, union is liable to take place with considerable shortening
and deformity (Fig. 69).

[Illustration: FIG. 69.--Fracture of the Femur just below the Small
Trochanter united, showing flexion and lateral rotation of upper
fragment.]

_Treatment._--When it is found, under an anaesthetic, that the
displacement can be completely reduced, and does not tend to recur,
this fracture is treated on the same lines as fracture of the shaft of
the bone.

In cases in which the proximal fragment cannot be brought into line
with the distal one, however, it is necessary to flex, evert, and
abduct the thigh in order to get the fragments into apposition and
into line. A Hodgen's splint (Fig. 77) is applied with the highest
sling under the upper end of the lower fragment and with sufficient
extension to correct overriding. The upper end is then strongly lifted
by a counter-weight of about 15 lbs. This secures apposition of the
fragments