THE FEMUR

Range 'short.'

Wounds small, impact direct, very little fine comminution. The bone
united without shortening of the limb.]

Other tracks took a direction of longitudinal obliquity, and then
implicated both epiphysis and diaphysis. Fig. 52, p. 169, shows an
example, and also the peculiarity likely to be assumed by the exit
aperture in the bone, especially if the bullet was travelling at a low
rate of velocity, a considerable plate of the compact bone being driven
out. In some cases these oblique tracks involved both femur and tibia.
They will be referred to again under the heading of injuries to the
joints, and some remarks will also be found there regarding the synovial
effusion so often occurring into the knee-joint in cases of fracture of
the shaft of the bone.

It may be of interest to insert here a few remarks as to the clinical
characteristics of fractures of the femur. First with regard to the
primary signs and symptoms. A very considerable degree of general or
constitutional shock usually accompanied them, and this was perhaps more
constant than in the case of any other injury in the body. This was,
moreover, no doubt increased by the unfavourable conditions in which
patients on the field of battle are situated in regard to transport.
When the patients were brought into hospital some delay in the primary
treatment was often necessary until reaction took place. Local shock to
the part was also a prominent feature. Abnormal mobility was very free
in the badly comminuted cases. Crepitus was often loose, and of 'the bag
of bone' variety. The result of local shock and consequent flaccidity of
the muscles was to reduce the development of primary shortening; in some
cases of severe comminution this was practically nil during the first
day or two, when, with return of tone in the muscles, it sometimes
became very considerable. Swelling of the limb was often very great, and
vascular injury definitely far more common than in the fractures of
civil practice, in consequence, no doubt, not only of the number and
sharpness of the fragments, but also of the force with which they were
driven into the surrounding tissues. The exit segment of the track was
out of all proportion in size to the entry, as a result of the
propulsion of bone fragments through it. This often made the closure of
the exit wound a very protracted event, the track continuing to
discharge a small quantity of bloody serum and fragments of necr