Art cannot always, with certainty, command such success, and perhaps, even at a less advanced period, a more rapid progress of reunion might leave but little ground for hope. But, could only an inch in length be gained by permanent extension, would it not be proper to have recourse to it, particularly as no inconvenience can result from the trial? To prevent deformity altogether, is the first object of art; but when that cannot be attained, to lessen it is the second. FRACTURES OF THE UPPER END OF THE OS FEMORIS. The history of fractures of the upper end of the os femoris, includes, 1st, Those of the great trochanter: 2dly, Those of the neck. These fractures, sometimes existing together, and at other times separately, are very different with regard to the frequency of their occurrence: the one taking place very rarely, has but slightly engaged the attention of practitioners, who have multiplied their researches with regard to the other, particularly in late years. FRACTURES OF THE GREAT TROCHANTER. § X. OF THE VARIETIES AND CAUSES. 77. Fractures of the great trochanter are the effect either of falls on that protuberance, or of the action of bodies striking against it. Oblique or transverse, situated sometimes at its summit, and sometimes at its base, these fractures may be either simple or complicated. They are rendered complicated sometimes by splinters and a swelling, as happens when a ball produces the division, and at other times by a fracture of the neck of the bone, an example of which we find in the Journal of Surgery, in the case of a man seventy years of age, who had been long subject to the itch. 78. Whatever the varieties may be, the fracture will be characterized, 1st, By a facility of moving the great trochanter in every direction, while the pelvis and the thigh remain without motion: 2dly, By a crepitation, arising from the friction of the divided surfaces against each other: 3dly, By there being no shortening of the limb, when the fracture exists alone: 4thly, By the fragments being brought together in abduction, and separated in adduction: 5thly, By the position of the great trochanter being higher and more anterior than natural. The presence of these signs is the more readily perceived, because, being superficially situated, this protuberance can be easily felt, and yields to the motions impressed on it. § XI. OF THE REDUCTION, AND THE MEANS OF RETAINING IT. 79. The reduction is effected, by pushing the separated fragment in the direction opposite to that of its displacement, by bringing it to its natural level, and, in certain cases, by moving the thigh a little outwards; it is retained by means of some compresses placed by its sides, and secured by a roller directed obliquely from the sound hip towards that part of the thigh corresponding to the fracture, and representing a true spica bandage.