once rendered useless, and there
is great swelling from effusion of blood in the region of the
fracture. This, together with the muscularity of the part, often
renders an accurate diagnosis as to the site and direction of the
fracture exceedingly difficult. The shortening varies from 1/2 inch to
3 or 4 inches--averaging about 1 inch in adults--and eversion is
always marked. Mobility may be detected and crepitus elicited without
disturbing the patient, by placing the hand under the seat of fracture
and gently attempting to raise the limb; or by fixing the proximal
fragment by one hand placed in front of it while the distal part of
the limb is carefully lifted. It will be found that the great
trochanter does not rotate with the lower segment of the femur. These
tests must be employed with great caution lest the deformity be
increased or the fracture rendered compound.

In many fractures of the thigh, and especially in those produced by
indirect violence, the knee is sprained, and there is a considerable
effusion into the joint, and this may lead to stiffness unless massage
is employed from the outset.

_Treatment._--Fracture of the shaft of the femur is one of the most
difficult fractures in the body to treat successfully. In cases of
oblique fracture, the patient should be warned that shortening to the
extent of from 3/4 to 1 inch is liable to result, however carefully
the treatment may be carried out. This does not necessarily imply a
permanent limp, as by tilting the pelvis he may be enabled to walk
quite well; if this is not sufficient to equalise the length of the
limbs, the sole of the boot may be raised. A general anaesthetic is
necessary to ensure accurate reduction, and extension must be applied
to maintain the fragments in apposition and prevent shortening. The
splint which has been found most generally useful is the Thomas' knee
splint, the ring of which rests against the ischial tuberosity. To
admit of flexion at the knee the Thomas' splint should have a hinged
attachment on which the leg is supported. This leaves the knee free
and allows of movement being made to prevent stiffness. The limb is
suspended by broad strips of flannel or linen, fixed to the side bars
of the splint by means of safety pins or strong spring paper clips.

In simple fractures extension may be obtained by means of broad strips
of adhesive plaster applied to each side of the thigh and reaching
well above its middle. The plaster is sec