THE HIP- JOINT 425 



Bryant's method involves the measurement of the vertical 

 distance between the highest point on the greater trochanter 

 and the horizontal plane passing through the anterior superior 

 iliac spines. This distance is normally .about two inches. 

 Asymmetry points to unilateral deformity and symmetrical 

 measurements, with marked deviation from the normal two 

 inches, to bilateral deformity. 



A comparison of the length measurements of the two limbs 

 is of great value to the surgeon in relation to injury or disease 

 in the region of the hip. Before proceeding with the actual 

 measurements, it is very important to see that the pelvis is not 

 tilted to one side and to make certain that the patient's limbs 

 are both in exactly the same position. To discover any lateral 

 tilting of the pelvis, a line is drawn from the anterior superior 

 spine of the ilium at right angles to the linea alba, and this, 

 when produced, should pass through the anterior superior spine 

 of the other side. 



Measurements should be taken from the anterior superior 

 spine to the distal margin of the medial condyle of the femur 

 and from that point to the medial malleolus, and these measure- 

 ments should be compared with those obtained on the opposite 

 limb. From this comparison any inequality of the two limbs 

 can be referred to the bone at fault, either the femur or the tibia 

 as the case may be, and this method is therefore of much greater 

 value than the direct measurement from the anterior superior 

 spine to the medial malleolus. When femoral shortening is 

 discovered, the deformity can be referred to the shaft or the neck 

 by comparing the measurements from the tips of the greater 

 trochanters to the distal borders of the lateral condyles. If 

 these are found to be equal, the deformity must be in the femoral 

 neck. Shortening of the femoral or tibial shaft may arise as a 

 result of infantile paralysis. 



It is by no means unusual for the length measurements to 

 show trifling differences, and, unless this exceeds half an inch, 

 no stress should be laid on it. 



The measurements are usually carried out with the patient 

 in the dorsal decubitus, and care must be taken to see that the 

 limbs have the same position relative to the trunk as they have 

 in the erect attitude. This precaution is essential, as the distance 

 between the anterior superior spine and the medial condyle is 

 definitely shorter in abduction than it is in adduction of the 

 thigh. Hence if the diseased limb is abducted, it is shortened, 



