A treatise on orthopedic surgery . hysical signs are similar to those of theanterior displacement. Diagnosis.—The diagnosis offers no difficulty. The historyof the limp or waddle noticed when the child began to walk andyet unaccompanied by pain or preceded by injury or disease isin itself sufficiently distinctive. If the displacement is of oneside, measurement demonstrates the shortening as compared35 Bilateral anterioi- con-genital dislocation. Tlielordosis is far lessmarked than in the or-dinary form. 546 ORTHOPEDIC SUHGEFY. with the other limb, a shortening that is explained bj theprominenc
A treatise on orthopedic surgery . hysical signs are similar to those of theanterior displacement. Diagnosis.—The diagnosis offers no difficulty. The historyof the limp or waddle noticed when the child began to walk andyet unaccompanied by pain or preceded by injury or disease isin itself sufficiently distinctive. If the displacement is of oneside, measurement demonstrates the shortening as compared35 Bilateral anterioi- con-genital dislocation. Tlielordosis is far lessmarked than in the or-dinary form. 546 ORTHOPEDIC SUHGEFY. with the other limb, a shortening that is explained bj theprominence of the trochanter and its elevation above ISTelatonsline. Traction or upward pressure on the limb will demonstratethe abnormal mobility of the displaced head; and finally, if thethigh be flexed and adducted to its extreme limit, the neck andhead of the femur can be easily distinguished moving under thegluteal muscles when the limb is rotated. Thus it may bedifferentiated from depression of the neck of the femur (coxa Fig. Bilateral congenital dislocation of the liip. vara), in which, although the trochanter is elevated, the neckand head of the bone cannot be felt, and in which the abnormalmobility, characteristic of the dislocation, is absent. Again,coxa vara is almost never a congenital affection; therefore, thehistory itself would practically exclude it. Upward disiDlacement of the femur not infrequently followsinfectious epipliysiiis or arthritis of infancy or early such cases a part of the upper extremity of the bone isusually destroyed, so that the head cannot be distinguished onpalpation. Although the other physical signs are similar to CONGENITAL DISLOCATION OF HIP AND COXA VARA. 547 Fig. 358. those of the congenital displacement, the scars about the jointpresent the evidence of former disease, and the history is almostalways available for diagnosis. Thus, as a rule, such disabili-ties, as well as traumatic dislo-cations or other results of in-jury
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