ety, or, if complete, is transverse and sub-periosteal,
and as it is accompanied by few symptoms and but little deformity, is
liable to be overlooked.

When there is displacement, the deformity is similar to that in
adults, and the treatment is carried out on the same lines.

In young children the nursing is greatly facilitated by applying
vertical extension to one or both lower extremities (Fig. 79). If the
fracture is transverse and shows little tendency to displacement, the
local Gooch splints may be dispensed with; in any case, massage should
be employed from the first.

The patient may be allowed out of bed in from three to four weeks,
wearing a retentive apparatus.

The shaft of the femur is sometimes fractured _during delivery_,
particularly in breech cases. The simplest and most efficient means of
controlling the fracture is by extension strapping fixed to the lower
end of a Thomas' knee splint.

CHAPTER VII

INJURIES IN THE REGION OF THE KNEE AND LEG

_Surgical Anatomy_--FRACTURE OF LOWER END OF FEMUR: _Supra-condylar_;
_T- or Y-shaped_; _Separation of epiphysis_; _Either
condyle_--FRACTURE OF UPPER END OF TIBIA: _Of head_; _Separation
of epiphysis_; _Avulsion of tubercle_--DISLOCATIONS OF KNEE:
_Dislocations of superior tibio-fibular joint_--INTERNAL
DERANGEMENTS OF KNEE--INJURIES OF PATELLA: _Fractures_;
_Dislocations_--INJURIES OF LEG: _Fracture of both bones_;
_Fracture of tibia alone_; _Fracture of fibula alone_.

INJURIES IN THE REGION OF THE KNEE

These include the supra-condylar fracture of the femur, the T- or
Y-shaped fracture opening into the joint, separation of the lower
femoral epiphysis; fracture of the head of the tibia, and separation
of its upper epiphysis; the various sprains and dislocations of the
knee, as well as its internal derangements; and fractures and
dislocations of the patella.

#Surgical Anatomy.#--Of the two epicondyles the medial is the more
prominent and palpable. The adductor tubercle, which is situated on
the upper and back part of the medial epicondyle, gives attachment to
the round tendon of the adductor magnus, and marks the level of the
epiphysial line and of the upper limit of the trochlear surface of the
femur. Between the medial condyle of the femur and the medial condyle
(tuberosity) of the tibia, when the limb is in the flexed position,
the line of the joint can be recognised as a groove or cleft, and this
is made u