und to
be relaxed on the side of the injury.

The violence being as a rule indirect, there is at first little or no
discoloration in the vicinity of the hip, but this may appear a few
days later.

Crepitus is not a constant sign, and should not be sought for, as the
necessary manipulations are liable to disengage the fragments and to
increase the deformity. For the same reason rotatory movements are to
be avoided.

In all cases in which the diagnosis is uncertain, the patient should
be put to bed, and treated as for a fracture. In the course of a few
days it is nearly always possible to make an accurate diagnosis.

In examining an old person who has sustained an injury in the region
of the hip, it should be borne in mind that the limb may be shortened
and everted as a result of arthritis deformans, and that the symptoms
of that disease may simulate those of fracture. In arthritis
deformans, however, the ilio-tibial band of the fascia lata is not
relaxed as it is in fracture.

[Illustration: FIG. 63. Fracture of Neck of Right Femur, showing
shortening, abduction, and eversion of limb.]

In some cases, and particularly in those in which the periosteum of
the neck and the retinacular ligaments remain intact, the shortening
does not become apparent till a few days after the accident. As the
other symptoms are correspondingly obscure, the condition is apt to be
mistaken for a bruise. In all doubtful cases the part should be
examined from day to day, and, if possible, the X-rays should be used.

In _impacted_ cases the signs of fracture are often obscure, and the
patient may even be able to walk after the accident. The skin over the
trochanter is generally discoloured from bruising. Eversion is usually
present, but there may be little shortening. Crepitus is absent. In
old people it is never advisable to undo impaction, as the
interlocking of the bones favours the occurrence of osseous union.

_Prognosis._--A fracture of the neck of the femur in an old person is
always attended with danger to life, a considerable proportion of the
patients dying within a few weeks or months of the accident from
causes associated with it. In some cases the mental and physical shock
so far diminishes the vitality of the patient that death ensues within
a few days. It is possible that fat embolism may account for death in
some of the more rapidly fatal cases. In others, the continued dorsal
position induces hypostatic congestion of the