A treatise on orthopedic surgery . description of the distortionand of its direct effects upon the function of the joint. Whenthe neck of the femur is depressed, for example, to a right anglewith the shaft, the trochanter is elevated to a correspondingdegree above JSTelatons line, and forms a noticeable projectionas contrasted with the normal contour (Fig. 382), a projectionthat becomes more marked when the thigh is flexed and adducted 576 OBTHOPEDIC SUBGEEY. (Fig. 384). In most instances the neck is twisted backwardfollowing the line of least resistance in its downward course andas the head o
A treatise on orthopedic surgery . description of the distortionand of its direct effects upon the function of the joint. Whenthe neck of the femur is depressed, for example, to a right anglewith the shaft, the trochanter is elevated to a correspondingdegree above JSTelatons line, and forms a noticeable projectionas contrasted with the normal contour (Fig. 382), a projectionthat becomes more marked when the thigh is flexed and adducted 576 OBTHOPEDIC SUBGEEY. (Fig. 384). In most instances the neck is twisted backwardfollowing the line of least resistance in its downward course andas the head of the bone remains in the acetabulum the trochan-ter is thrown forward and the limb is rotated outward. Theability to abduct the thigh is dependent upon the upward incli-nation of the femoral neck (Fig. 389) ; when, therefore, this in-clination is diminished the range of abduction is lessened, inpart by the greater tension that is exerted upon the lower por-tion of the capsule, in part by the direct contact of the rim of Fig. Skiagram of coxa vara ; deformity most marked at the epiphyseal illustrates the mechanical limitation of abduction caused by the deformity,and the compensatory tilting of the pelvis. The patient is shown in Fig. 385. the acetabulum with the neck (Fig. 382), and in part by the adap-tive muscular retractions that always accompany distortions ofthis character. The distortion of the neck in a direction back-ward and downward changes the relation of the acetabulum tothe head of the femur, so that abduction or flexion tends to dis-place it from its socket. Thus the range of abduction, of in-ward rotation, and of flexion is limited, while that of adduction,outward rotation, and extension may be increased. There is actual shortening of the limb dependent upon theupward displacement of the shaft of the femur. This is not CONGENITAL DISLOCATION OF HIP AND COXA VARA. 577 often more than an inch in the ordinary type of adolescent de-formity, but th
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