Lectures on orthopedic surgery . ion may be of both hips or of only one. In ourexperience it is more frequently unilateral. The symptoms are not sufficiently pronounced toattract attention until the child begins to walk, or untilit has walked for some months. In unilateral cases thesymptom that then attracts attention is a limp ; in bi-lateral cases it is a waddling gait, a sway-back and aprominent abdomen. The limp, or the waddle whichis simply a double limp, is due to the shortening and theinsecurity of the femoral head for weight-bearing whendisplaced from its bony socket and resting on the
Lectures on orthopedic surgery . ion may be of both hips or of only one. In ourexperience it is more frequently unilateral. The symptoms are not sufficiently pronounced toattract attention until the child begins to walk, or untilit has walked for some months. In unilateral cases thesymptom that then attracts attention is a limp ; in bi-lateral cases it is a waddling gait, a sway-back and aprominent abdomen. The limp, or the waddle whichis simply a double limp, is due to the shortening and theinsecurity of the femoral head for weight-bearing whendisplaced from its bony socket and resting on the but-tock muscles. The leg is shortened from ^ inch ininfancy to If at 7 or 8 years of age and 2J to 3 inches inadult life. There will be found an upward displace-ment of the greater trochanter equal to the amount ofshortening. If a cord be drawn from the anterior 334 superior spine of the ilium across the hip to the tuber-osity of the ischium it will be found in the normal topass across the tip of the greater trochanter; in the. Fig. 261.—Congenital dislocation of the right hip. congenitally dislocated hip it will pass below this pointby as much as the limb is shortened. The limb is 335 smaller and flabbier than the sound Umb. The upperportion of the buttock is prominent; the lower portion isflat; the hip is broadened laterally ; the perineum isbroadened, noticeably in bilateral cases; the pelvis istilted forwards, giving lumbar lordosis and a prominentabdomen, more marked in bilateral than in unilateralcases and increasing with age. All of these symptomsare more noticeable when the patients stand than whenthey lie. In cases of some standing a certain amountof flexion deformity is found by the Thomas flexiontest. Movement at the hip in flexion, adduction andinward rotation are as free and often are freer thannormal, while adduction, outward rotation and exten-sion are restricted to some extent. In a word, anymotion that throws the femoral head against the dorsumof the ilium
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
