of cords passing obliquely over a pulley
attached to an upright at the foot of the bed, the weight of the limb
is made to act as the extending force.

[Illustration: FIG. 77.--Hodgen's Splint.]

The retentive apparatus should be worn for from six to eight weeks,
after which the patient is allowed up with crutches, which he usually
requires to use for three or four weeks longer, before he can bear his
weight upon the limb. The old dictum of Nelaton, that the treatment of
fracture of the thigh should last for a hundred days, is a safe
working-rule. In fractures of the shaft an ordinary Thomas' knee
splint, or a "walking calliper splint" which is fixed to the heel of
the boot, may be worn when the patient gets up.

Union may be exceedingly slow in fracture of the femur, and may even
be delayed for months. Mal-union sometimes occurs, the fracture
uniting with an angular deformity outward and forward.

Re-fracture is liable to occur if the patient falls or twists the limb
within a few months of the original injury. It has happened not
infrequently just after the retentive apparatus has been removed from
the nurse raising the limb by the foot in order to wash it.

_Liston's long splint_ is only employed as a temporary expedient for
immobilising the fragments during transport; a Thomas' splint, if
available, is better for this purpose.

[Illustration: FIG. 78.--Long Splint with Perineal Band.]

_Operative treatment_ is sometimes called for when simpler measures
fail to reduce the displacement, and in cases of un-united fracture or
of vicious union. The incision, which must be free, is preferably
placed in the line of the lateral intermuscular septum; the
periosteum is interfered with as little as possible. The application
of extension by the calliper method is often of great service, during
the operation, in enabling the operator to get the fragments into
position; sometimes no fixation is required, but, if necessary,
recourse is had to plating or pegging, or an intra-medullary pin. The
extension apparatus is retained for three or four weeks. The
after-treatment is carried out on the same lines as for simple
fracture, but the retentive apparatus must be worn for a considerably
longer period.

[Illustration: FIG. 79.--Fracture of Thigh treated by Vertical
Extension.]

#Fracture of the Femur in Children.#--In children, especially below
the age of ten, this fracture is quite common. It is often of the
greenstick vari