egion, on the other hand, is not uncommon. It is
produced by a fall on the trochanter, and gives rise to symptoms which
simulate to some extent those of fracture of the neck. The limb lies
in the position of slight flexion, but the bony points retain their
normal relationship to one another, and there is no shortening. The
swelling and tenderness often prevent a thorough examination being
made, and when any doubt remains as to the diagnosis, the patient
should be kept in bed till the doubt is cleared up by the use of the
X-rays. If the bone has been broken, this will reveal itself in the
course of a few days by the occurrence of shortening and other
evidence of fracture.

In elderly patients, contusion of the hip may be followed by changes
in the joint of the nature of arthritis deformans; and it has been
stated, although proof is wanting, that absorption of the neck of the
femur sometimes occurs. These injuries are treated by rest in bed,
massage, and the other measures already described as applicable to
sprains and contusions.

FRACTURE OF THE SHAFT OF THE FEMUR

This group includes all fractures between that immediately below the
lesser trochanter and the supra-condylar fracture.

_In adults_, when due to direct violence, the fracture is usually
transverse, and may be attended with comparatively little
displacement. Indirect violence, on the other hand, usually produces
an oblique fracture, which is frequently comminuted and often
compound. The break is most commonly situated a little above the
middle of the shaft, the obliquity being downward, forward, and
medially, and of such a nature that the fragments tend to override one
another (Fig. 75). The most serious forms are those associated with
gun-shot wounds.

[Illustration: FIG. 75.--Longitudinal section of Femur showing recent
Fracture of Shaft with overriding of Fragments.]

The direction and nature of the displacement depend more upon the
fracturing force, the weight of the lower part of the limb, and the
action of the muscles attached to the respective fragments, than upon
the direction of the obliquity. As a rule, the proximal fragment
passes forward and laterally, and is maintained in this position by
the ilio-psoas and glutei muscles, while the distal fragment is
displaced upward and medially and is rotated outward by the combined
action of the weight of the limb, the longitudinal muscles, and the
adductors.

_Clinical Features._--The limb is at