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Fractures of the Neck of the Thigh-bone.There is another reason why fractures occur at the neck of the thigh-bone more frequently in elderly people than in younger persons. This reason is that the neck of the bone changes its position with regard to the shaft. In young persons the neck forms an oblique angle with the shaft, while in old age the neck is lowered so that it makes almost a right angle with the body of the bone. Fracture of the neck of the thigh-bone occurs almost always as the result of a fall upon the hip or upon the knees. Yet in some cases the bone is fractured by force applied to the feet; thus it may result from simply stepping somewhat heavily down a stair. Indeed it is surprising to observe what slight causes have been known to produce this fracture in elderly people. Tripping upon the carpet or getting the foot entangled in the bedclothes have been observed to occasion such a fracture. Whenever an elderly person experiences a sharp pain, accom panied with lameness or inability to walk, after such a trifling accident, we should suspect the existence of this fracture and examine the hip. This fracture is very often impacted ; that is the lower fragment is driven firmly into the upper. It is important to distinguish whether or not impaction has occurred, since the treatment will vary somewhat in different cases. Several signs are present in both impacted and non-impacted fractures. These are pain and swelling around the hip joint; turning out of the foot, the toes being directed away from the opposite leg; shortening of the limb, flattening of the hip, the bony prominence being less distinct than on the opposite side ; loss of power to use the leg. In addition, we may remember that the fracture usually occurs from a blow upon the hip, or from some sudden wrenching of the limb. There are two signs whereby we can distinguish a non-impacted from an impacted fracture of the neck of the thigh-bone. These are: First-An unnatural mobility of the thigh. This, of course, results from the fact that the two fragments are entirely separate, so that the movements of the limb are not restricted by the barriers natural to the hip-joint. Second-A grating sensation can often be felt when the thigh is moved around somewhat forcibly. If the fracture be impacted, on the other hand, the movements of the limb will be less and not more than natural, and no grating sensation can be felt. Fractures of the neck of the thigh-bone are sometimes confounded with dislocation of the hip. It is important that we recognize the difference at once, since a dislocation of the hip can be reduced and the patient be about again in a few days, while a fracture at the neck of the bone rarely heals completely in an elderly person. The following points of distinction will enable any one to recognize the difference between a dislocation of the hip and a non-impacted fracture of the neck of the bone. First-In dislocation of the hip there is no grating sensation ; in fracture there is. Second-In dislocation the bone cannot be replaced except with difficulty ; in fracture the limb can be readily straightened, but does not ret'ain its natural position. Third-In dislocations the foot is usually turned inward, the toes toward the opposite leg ; in fractures the toes are usually turned outward. Fourth-In dislocations the limb remains fixed in one position, no motion being obtainable at the hip-joint ; in fractures, on the other hand, the thigh can be moved by a second person. Treatment.-The treatment of fractures of the neck of the thigh-bone in elderly persons is usually unsatisfactory, and sometimes quite useless. The result depends rather upon the condition of the individual than upon the particular dressing used. Perfect recovery never takes place ; in some cases, union occurs by means of a membrane or ligament, and not of true bone. In a considerable number of cases the fragments do not unite at all. The limb is always perceptibly shortened, and the individual is often permanently lame. Sometimes the shock caused by the injury results in prostration of the patient, and causes death in a few months. The treatment varies according as the fracture is or is not impacted. This point should, therefore, be decided before the leg has been roughly moved or examined. If the fracture be impacted, nothing further is necessary than perfect repose for the limb ; the patient should be kept upon his back in bed. If the fracture be not impacted, the treatment should aim at the accomplishment of three objects : First, the ends of the bone should be replaced ; the lower fragment should be drawn downward, to prevent shortening ; the limb must be kept perfectly quiet. The bone can usually be set without much difficulty. One person grasps the hip and pulls strongly toward the head, while an assistant seizes the leg and draws it forcibly toward the foot of the bed. It will sometimes happen that the parts remain almost in position even after the force is relaxed ; in most cases, however, the displacement of the broken ends takes place again so soon as the pulling is discontinued. It is therefore necessary to apply the dressing while the extension of the limb is still maintained. The simplest dressing consists in a strip of board, three or four inches wide, and long enough to extend from the lower ribs to a point several inches beyond the sole of the foot. A cross piece should be fastened to the lower end, in order to keep the splint upright. This splint is to be well padded and applied to the limb while the patient lies upon his back in bed and the assistants hold the limb in position. The splint is firmly bound to the limb by a bandage which passes around the waist and hips, and by a second bandage, narrower than the first, which extends from the foot to the thigh. If the limb be very muscular, it will be necessary to use one of the splints described in the previous chapter for fractures of the shaft of the thigh-bone. In most cases, however, it will not be advisable to torture the patient with dressings which compel him to remain upon his back in one position for a month, for the most that we can hope for is a serviceable and not a perfect union of the fragments ; there will probably be shortening and permanent lameness ; moreover, the patient is usually old and feeble, and his health will be seriously impaired by the confinement and the rigorous dressing necessary to the most perfect result. It will therefore be better, in treating fractures of the neck of the thigh-bone in aged and infirm persons, to apply the splint already indicated for a couple of weeks, and then to remove it and trust to simple repose to effect the healing. Indeed in many instances it becomes absolutely necessary to relieve the patient from the burden of a dressing, and to give him some air and recreation, in order to save his life. The exact dressing, the time during which it is to be applied, must be in every case determined by the circumstances and by the general condition of the individual. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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