For purposes of clinical diagnosis it is necessary to locate certain bony prominences, the most important being--(1) The _anterior superior iliac spine_, which is most readily recognised by running the fingers along Poupart's ligament towards it. (2) The _ischial tuberosity_, which in the extended position of the limb is overlapped by the lower margin of the gluteus maximus muscle, and is therefore not easily located with precision. By flexing the limb and making pressure from below upwards in the gluteal fold, the smooth, rounded prominence can usually be detected. (3) The quadrilateral _great trochanter_ is readily recognised on the lateral aspect of the hip. Its highest point or _tip_ can best be felt by pressing over the gluteal muscles from above downwards. _Clinical Tests._--If a line is drawn from the anterior superior iliac spine to the most prominent part of the ischial tuberosity, it just touches the tip of the great trochanter. This is known as _Nélaton's line_ (Fig. 58). [Illustration: FIG. 58.--Nélaton's Line.] _Bryant's test_ (Fig. 59) is applied with the patient lying on his back, and consists in dropping a perpendicular AB from the anterior superior iliac spine, and drawing a line CD from the tip of the great trochanter to intersect the perpendicular at right angles. This is done on both sides of the body, and the length of the lines CD compared. Shortening on one side indicates an upward displacement of the trochanter, lengthening a downward displacement. The third side AC of the triangle indicates the distance between the anterior spine and the tip of the trochanter. [Illustration: FIG. 59.--Bryant's Line.] _Chiene's test_, which is simpler than either of these, consists in applying a strip of lead or tape across the front of the body at the level of the anterior superior iliac spines, and another touching the tips of the two trochanters. Any want of parallelism in these lines indicates a change in the position of one or other trochanter. FRACTURE OF THE UPPER END OF THE FEMUR The fractures of the upper end of the femur that are liable to be confused with one another and with dislocations of the hip, include fractures of the head, the neck, the trochanters, and separation of the upper epiphyses, and fracture of the shaft just below the trochanters. Fracture of the #head of the femur# is rare, and is usually a complication of backward dislocation of the hip. It takes the form of a split of the articular surface caused by impact against the edge of the acetabulum, and is analogous to the indentation fracture of the head of the humerus, which may accompany dislocation of the shoulder. The #epiphysis of the head#, which lies entirely within the capsule of the joint (Fig. 60), is occasionally separated, and the symptoms closely simulate those of fracture of the narrow part of the neck. If the condition is overlooked or imperfectly treated, it may in course of time be followed by coxa vara.