734 APPENDIX.
instead of turning upon it as a hinge. The whole upper part of the bone, above the trochanter minor, seemed to have been bent inward, so that the posterior intertrochan- teric line, instead of inclining obliquely to the axis of the shaft, was vertical. The inversion was due to the extent of the comminution, which had separated the walls of the shaft so as to receive in the interval the whole neck, in- stead of the posterior wall only, as commonly occurs, thus producing an anterior as well as a posterior impaction. The shortening resulted both from the horizontal position of the neck, and from an additional upward displacement of the shaft, caused by the comminution. A good deal of callus had been thrown out in various directions, and the movements of the limb must have been quite restricted. A curious spicula stood at right angles with the shaft, near the lesser trochanter, and may have been a displaced frag- ment, or the ossified insertion of the psoas tendon. The same bony spicula exists in another specimen before me, and is not uncommon.
" In examining the accompanying illustrations (of which there are two), it will be seen that the intertrochanteric ridge is split off, as often happens, but in this it has carried with it the outer and posterior walls of the shaft, with the two trochanters.
"Smith (Treatise on Fractures, etc., Dublin) cites a similar case of inversion (Case XLVI.), which the accompa- nying figure shows to have resulted from a similar cause. The posterior intertrochanteric ridge, with the greater part of the two trochanters, has been detached in a mass, and so widely that the neck of the bone has slipped from its anterior hinge. In both specimens the impaction is arrested near the outer wall of the shaft. The entire neck in my specimen can be seen through the lateral fissures, while in that of Smith its extremity is detected through an interval of the fragments, near the great trochanter. A similar specimen, numbered 248, in the Mutter Museum in Philadelphia, shows neither inversion nor eversion." 1870.
Dr. H. J. Bigelow.
3651. Fracture of the neck of the femur, within the capsule. The neck is almost entirely absorbed, and the head is con-
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