JUXTA-EPIPHYSEAL FRACTURE OF THE UPPER END OF FEMUR. THE IMPORTANCE OF THE USE OF POSITION IN ITS TREATMENT

First.—Epiphyseal disjunction at the hip occurs from all degrees of trauma to none at all, and very largely in the adolescent period; never above twenty-one or twenty-two years of age; rarely under ten [SEE FIG-6 IN SOURCE PDF.]

Second.—It may be mistaken for the various hip joint affections.

Third.—Epiphyseal coxa vara may apparently be a contributing cause to a flattening of the head associated with mild symptoms in later life, also to osteoarthritis.

Fourth.—The Rontgen ray is undoubtedly disclosing many of these cases, which would, otherwise, have been diagnosed differently. [SEE FIG 7. IN SOURCE PDF.]

Fifth.—Mild cases, with slight displacement, of long standing, do very well under immobilizing or supporting treatment.

Sixth.—The author wishes to emphasize, as pointed out by Whitman, the unnecessary use of internal metal sutures, nails or splints, when the distal or controllable fragment is placed and held in alignment with the capital fragment by a position of abduction and inward rotation. This is, in the experience of the author, best accomplished by the use of a long plaster-of-Paris spica, with the knee flexed to a right angle. In this way the lower leg acts as a lever and holds firmly the desired inward rotation.

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