CHAP. XXI. Of the fracture of the Thigh nigh to the joint, or the upper or lower head of the bone.
A Fracture sometimes happens at the joint of the hip in the neck of the thigh-bone,* 1.1 as I once observed in an honest matron. I being called to her, when I had observed the hurt thigh to be shorter than the whole, with the outward prominency of the Ischium, which at the first sight I supposed to proceed from the head of the thigh-bone, I presently perswaded my self it was a dislocation and no fracture; I then therefore extended the bone, and forced (as I thought) the head thereof into its cavity. The equality of both the legs in bigness which followed upon this extension, encreased my perswasion that it was a dislocation. The next day I visited her the second time, and found her in great pain, her hurt leg the shorter, and her foot wrested inwards. Then I loosed all her ligatures, and perceived such a prominency as I did formerly: Where∣fore I endeavoured again to force in the head of the bone, as I formerly did; But as I was busied therein, I heard a little crackling, and also I considered that there was no cavity nor depression in the joint, by which signs I certainly perswaded my self, that the bone was broken; and not dislocated. Neither only such kind of fractures,* 1.2 but also the separation of the appendix or head of this bone from its place, may induce one to think it a dislocation; which thing hath some∣times deceived some heedless Surgeons, who have not dreamt of the divulsion or separation of the appendix from the top of the thigh-bone, but have judged it only a dislocation. Then there∣fore (that I may return to my former narration) I set the bone, and joined the fragments toge∣ther, laid thereupon splints with compresses, made ligations with a rowler, having two heads wrapped about the joint, and the body cross-wise, and I defended her foot with a case, that none of the cloths might press it: I fastned a rope to a poste, and so let it come down into the midst of the bed, and tyed many knots thereon, for the better taking hold and lifting up her self; the which thing you must alwayes doe in fractures and dislocations of the thigh and leg, that so your Patients may have some stay, whereby they may succour themselves with their hands, as oft as they desire to rise, or lift themselves up in their beds, or go to stool; as also, that they may give perspiration, and as it were ventilation to the loins, buttocks, rump, and other parts, compressed and wearied with long lying, for want whereof they are molested with heat and pain, whence ulcers arise, which oft-times torment the Patient with such tormenting heat and pain, that he is even consumed by a feaver, watchings, and want of rest.* 1.3 This opportunity of raising the body out of the bed, is by so much the more needfull in this place, by how much the fracture is nearer the joint; for there it is more dangerous than in the midst of the thigh, and conse∣quently more difficult to dress and heal, for that the part is bloodless, and by reason of the multi∣tudes of the nerves, tendons and ligaments, which are obnoxious to many malign symptoms: But the Surgeon must have diligent care in this kind of fracture, and must look often that the bone, which is set, doe not fall forth again, which easily happens here by any light stirring of the body, and the like occasion, for that the thigh hath but one only bone: Therefore, as oft as the Bandages shall be loosed, and the fracture dressed, he shall attentively view the figure of the bone, and the magnitude of the affected part, comparing it with the sound; for the set and composed frag∣ments of the broken bone, can scarce fall asunder, but that the one must lye upon the other. But before it be knit, the part must be extended and restored to its state, that so the Patient may