Licence: Public Domain Mark
Credit: Outlines of human pathology / by Herbert Mayo. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![tissue to the margin of the acetabulum. A very perfect false joint had formed between the fractured surfaceof thehead of the bone and the shortened neck: the new articular faces were of ivory bone. [g. 4.] A woman, fifty years of age, was treated, in the Middlesex Hospital, for an injury of the hip joint. After thirteen months, and when she had begun to walk with a crutch, she died suddenly of apoplexy. On examining the joint, the injury was ascertained to have been a fracture of the neck of the femur within the capsular membrane. The neck of the bone was, as usual, shortened; but the head was firmly united to it by soft substance. These two cases exemplify the appearances ordinarily found; and there are features in them, which make it sufficiently clear that the absence of bony union does not result from imperfect nutrition or inadequate supply of blood to the separated portion, [g. 5.] The best way perhaps of bringing out the facts upon this subject is to ask the three following questions. What is the reason, that fractures of the neck of the femur within the capsule do not unite as readily as fractures of other parts of the same bone ? Why, or by what process, do they ever unite ? Why are they so seldom found united ? In the account which has been given above of the union of the shafts of long bones, the surrounding tissues are described as taking a prominent part in the act of reparation. But in the case under consideration, these tissues are excluded by the untorn synovial and capsular membranes from communicat- ing with the fracture. They are sometimes, indeed, seen to make the ordinary effort towards reparation of the adjacent fracture. Thus a portion of an ossified provisional callus is often met with external to the attachment of the capsular membrane to the neck of the femur, [g. 5.] But the effort is ineffectual; the callus cannot reach the fracture, whe- ther it remains entirely disunited, or is glued together by an exudation from the ends of the broken bone. In the cases in which bony union takes place, I believe the process of ossification to be extremely slow. Such instances occur in those only, who are not greatly advanced in life at the time of the fracture; and in whom, through the care](https://iiif.wellcomecollection.org/image/b21066735_0045.jp2/full/800%2C/0/default.jpg)
