FRACTURES OF TUE NECK OF THE FEMUR These require long-continued rest on account of severe complications. All other treatment depends upon the complications.
When fresh these should be treated with a carefully moulded plaster cast, which ensures adaptation of the fragments in extreme abduction and inward rotation.
We prefer the plaster cast to the treatment with extension, because this alone will ensure good results in restless children owing to the difficulty of influencing the deep-lying fragments (see Fixation of the ends in intertrochanteric osteotomies).
The plaster east in abduction should be provided with a stirrup for walking and no weight should be allowed upon the fracture for eight weeks. Only by keeping off the weight for a long time can we avoid the possibility of a late bending of the neck of the femur into a coxa vara, especially since in this locality, more than in any other, osseous union may fail and only fibrous union take place, conditions which are caused by the difficulty in adapting the deep-lying fragments, by the poor nour ishment of the neck, and also by the great demands made upon the femur.
Hoffa, also Whitman, advise extirpation of the loose head in old badly healed fractures of the neck. Lorenz is successful with his inver sion; he tears through the insufficient sear under anwsthesia without cutting, leaves the head in the acetabulum and transposes the troehaater and the neck in abduction underneath the spine, thus giving in favorable cases a solid support upwards and a useful hip in abduction. This pro cedure is surely less dangerous than suture of the bone, which is always a severe operation owing to the opening of the large hip-joint.