followed by absorption of the neck, which delays or
may even entirely prevent union (Fig. 61). The second group usually
occurs in robust adults, and results from severe forms of violence
applied to the trochanter. In this group firm osseous union usually
takes place.

[Illustration: FIG. 61.--Fracture through Narrow Part of Neck of Femur
on section. The Neck of the bone has undergone absorption.]

#Fracture of the Narrow Part of the Neck# or #Intra-capsular
Fracture#.--This fracture is most frequently met with in elderly
persons, especially women, and is usually produced by comparatively
slight forms of indirect violence--such, for example, as result from
the foot catching on the edge of a carpet, a stumble in walking, or
missing a step in going downstairs.

The line of fracture, which is usually transverse but may be oblique
or irregular, lies for the most part within the capsule, and the
posterior part of the neck is more comminuted than the anterior. The
distal fragment, which includes the base of the neck, the
trochanters, and the shaft, is usually displaced upward and rotated
laterally. If the periosteum and the retinacular ligaments remain
intact, displacement is prevented and union favoured.

Impaction is less common than in fracture through the base of the
neck; it usually results from the patient falling on the trochanter,
the distal fragment being driven as a wedge into the proximal (Fig.
62).

[Illustration: FIG. 62.--Impacted Fracture through Narrow Part of Neck
of Femur.]

_Clinical Features._--In non-impacted cases the limb is at once
rendered useless, and the patient is unable to rise. There is pain and
tenderness in the region of the hip on making the slightest movement;
and a specially tender spot may be localised, indicating the seat of
fracture.

On placing the pelvis as square as possible, and comparing the
measurements of the limbs from the anterior superior spine to the
medial malleolus, shortening of the injured limb to the extent of from
1 to 3 inches may be found. On applying Nelaton's, Bryant's, or
Chiene's test, the tip of the great trochanter will be found elevated.
It is also farther back and less prominent than normal.

The whole limb is usually everted to a greater or less degree, and is
slightly abducted. In some cases, when the impaction is of the
anterior portion of the neck, the limb is inverted. On comparing the
ilio-tibial band of the fascia lata on the two sides, it is fo