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IN considering the treatment of fractured neck of the femur, one is forced to pay tribute to the excellence of the results sometimes obtained by the use of the three-flanged nail. No one denies that, in a successful case, nothing could be better than the results obtained by its use. The operation is apparently not difficult, and the convalescence of the patient is easy and comfortable, but the excellence of the results sometimes obtained in skilled hands should blind us neither to its failures nor to the possibilities of other methods of treatment in certain cases.The three-flanged nail operation is not as easy as it seems and calls for a considerable amount of skill and judgement. There is no doubt that some people seem to have a greater facility for introducing pins than others, and, generally speaking, the man who is doing numbers of these operations does them with less difficulty and greater certainty than does the "occasional pinner". There is no doubt that a ,well placed pin is much more likely to give a good result than a badly placed one; in fact, to get union with a badly placed pin is almost a rarity. So m,ucli is this so that innumerable mechanical gadgets have been invented to aid the surgeon, but their very multiplicity suggests that none is really adequate.There are still some advocates of the open operation, but this has been practically abandoned in England and America. I think that the pinning operation loses much of its value if an extensive dissection has to be done, and it is agreed that dissection is followed by a greater number of cases of aseptic necrosis. But the "blind operation" demands adequate X-ray equip ment and technicians, and should be done only when conditions are favourable.The usual classification of fractures of the neck of the femur is as follows : 1 . Subcapital fracture. 2. Transcervical fracture. 3. Baml fracture: 4. The undiwlaced or impacted fracture. ( a ) Intertrochanteric, along the intertrochanteric line.(a) Pertrochanteric, more laterally placed.

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