On placing the pelvis as square as possible, and comparing the measurements of the limbs from the anterior superior spine to the medial malleolus, shortening of the injured limb to the extent of from 1 to 3 inches may be found. On applying Nélaton's, Bryant's, or Chiene's test, the tip of the great trochanter will be found elevated. It is also farther back and less prominent than normal. The whole limb is usually everted to a greater or less degree, and is slightly abducted. In some cases, when the impaction is of the anterior portion of the neck, the limb is inverted. On comparing the ilio-tibial band of the fascia lata on the two sides, it is found to be relaxed on the side of the injury. The violence being as a rule indirect, there is at first little or no discoloration in the vicinity of the hip, but this may appear a few days later. Crepitus is not a constant sign, and should not be sought for, as the necessary manipulations are liable to disengage the fragments and to increase the deformity. For the same reason rotatory movements are to be avoided. In all cases in which the diagnosis is uncertain, the patient should be put to bed, and treated as for a fracture. In the course of a few days it is nearly always possible to make an accurate diagnosis. In examining an old person who has sustained an injury in the region of the hip, it should be borne in mind that the limb may be shortened and everted as a result of arthritis deformans, and that the symptoms of that disease may simulate those of fracture. In arthritis deformans, however, the ilio-tibial band of the fascia lata is not relaxed as it is in fracture. [Illustration: FIG. 63. Fracture of Neck of Right Femur, showing shortening, abduction, and eversion of limb.] In some cases, and particularly in those in which the periosteum of the neck and the retinacular ligaments remain intact, the shortening does not become apparent till a few days after the accident. As the other symptoms are correspondingly obscure, the condition is apt to be mistaken for a bruise. In all doubtful cases the part should be examined from day to day, and, if possible, the X-rays should be used. In _impacted_ cases the signs of fracture are often obscure, and the patient may even be able to walk after the accident. The skin over the trochanter is generally discoloured from bruising. Eversion is usually present, but there may be little shortening. Crepitus is absent. In old people it is never advisable to undo impaction, as the interlocking of the bones favours the occurrence of osseous union.