A system of surgery : theoretical and practical . across the neck represents the area of disease. pain which finds its expression in the wince or limp of the child in walking. Thiswincing is also observed if the limb be gently over-extended, the head being thusthrust against the acetabulum by the leverage of the femur acting on the Y-ligamentand the tense anterior part of the capsule as a fulcrum (see fig. 73). It is for thisreason that the patient involuntarily flexes the thigh somewhat to relax the lattera little, and so relieve the pressure on the head due to the weight of the limb actingon
A system of surgery : theoretical and practical . across the neck represents the area of disease. pain which finds its expression in the wince or limp of the child in walking. Thiswincing is also observed if the limb be gently over-extended, the head being thusthrust against the acetabulum by the leverage of the femur acting on the Y-ligamentand the tense anterior part of the capsule as a fulcrum (see fig. 73). It is for thisreason that the patient involuntarily flexes the thigh somewhat to relax the lattera little, and so relieve the pressure on the head due to the weight of the limb actingon the same lever (fig. 74). Now, if synovitis were present, even supposing we were unable to detect eitherheat, redness, fluctuation, or tenderness on pressure, we should still find that thepatient had involuntarily fixed the joint to avoid any movement of its inflamed sur-faces one over the other, and if passive flexion or rotation were attempted, wouldresist voluntarily, with expressions of acute suffering. The thigh would be fixed in Fig. Letters as in the. last fig. d represents the diseased area. Here the limb is supposed to be flexed in order to decreasethe pressure of the head against the acetabulum and so relieve the strain on d ; of course the head is onlytheoretically withdrawn from the latter. the characteristic position of synovitis (fig. 72). These points will serve to distin-guish the two conditions from one another as long as they are distinct. The diagnosis of the femoral from the acetabular affection is, however, most diffi-cult in the earliest stages, if not impossible. Fortunately it is not as important todetermine which of the bones is the starting-point of the disease as it is to make outwhether the latter is commencing in the head of the femur or synovial tissues. So much for the earliest manifestations of the strumous affection. When thechanges already mentioned of caseation or softening of the granulation-tissue haveaffected the joint surfaces genera
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