It is now universally agreed that pertrochanteric fractures of the femur are best treated by internal fixation whenever this is feasible. Because many of the patients with pertrochanteric fractures are in an advanced state of senility, sometimes complicated by mild dementia and incontinence, the non-operative treatment of these fractures presents formidable nursing difficulties.

Not all pertrochanteric fractures of the femur are suitable for internal fixation by the blade plate, and attempted operation may cause such comminution in some cases that to persist with difficult surgery is not to be advised and the case is better returned to the ward for treatment on traction. There will always be a place for the non-operative treatment of the pertrochanteric fracture, and it is necessary therefore to decide what technical matters are of importance with regard to the comfort of the patient and the convenience of the nursing staff.

RUSSELL TRACTION

It is obvious that some form of balanced traction is the only rational method of non-operative treatment, because a plaster hip-spica is quite out of the question in patients of this degree of senility. The most generally used type of traction is that popularly known as Russell traction. In its original form Russell devised this system for the treatment of fractures of the shaft of the femur and he evolved the rather complicated system of pulleys in order to correlate the traction force necessary to maintain length with the upward lifting force necessary to correct backward angulation at the fracture.