A treatise on orthopedic surgery . in the upper extremity and in 50 per cent, of thecases the femur is ^ The tumor may be periosteal or central. If periosteal itsoutline is irregular. If central the bone is more uniformlyenlarged. In some instances, the pain, sensitiveness and swell-ing induced apparently by injury simulate very closely diseaseof the joint. As a rule, however, the disease of the bone is moremarked than that of the joint and an X-ray picture will indi-cate its destructive character. ^ Coley, Annals of Surgery, March, 1907. CHAPTER VII. TUBERCULOUS DISEASE OF THE HIP-J
A treatise on orthopedic surgery . in the upper extremity and in 50 per cent, of thecases the femur is ^ The tumor may be periosteal or central. If periosteal itsoutline is irregular. If central the bone is more uniformlyenlarged. In some instances, the pain, sensitiveness and swell-ing induced apparently by injury simulate very closely diseaseof the joint. As a rule, however, the disease of the bone is moremarked than that of the joint and an X-ray picture will indi-cate its destructive character. ^ Coley, Annals of Surgery, March, 1907. CHAPTER VII. TUBERCULOUS DISEASE OF THE HIP-JOINT. Synonyms.—Hip disease, morbus coxse. Hip disease is a chronic destructive disease that results in lossof function and deformity. At one time a number of patho-logical processes and even simple deformity (coxa vara) wereincluded under the title, but it is now limited to tuberculousdisease. Pathology.—Tuberculous disease of the hip-joint usually be-gins in several minute foci near the epiphyseal cartilage of the Fig. Section of the hip-joint at the age of eight years, showing the epiphyses andthe relation of the capsule. (Schuchardt.) At birth the entire upper extremityof the femur is cartilaginous. According to Jacinsky, ossification begins in thehead of the femur at about the tenth month; in the trochanter major at fromthe fourth to the eighth year; in the trochanter minor at the eleventh is complete at all points at about the eighteenth year. Range ofmotion at the hip-joint. Extension to 20 degrees beyond the horizontal; flex-ion to 70 degrees; total 140 degrees. Abduction, adduction, and rotation aremost free when the limb is flexed to 130 degrees. At this point the range ofabduction is 55 degrees, of adduction 35 degrees; total 90 degrees. Outwardrotation 40 degrees, inward rotation 20 degrees; total 60 degrees. If the limbIs completely extended the range of abduction is about 45 degrees; adduction,15 degrees.^ E. du Bois-Eaymond, Berlin, 19
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