426 THE INFERIOR EXTREMITY 



and if the sound limb is adducted so as to be parallel to it, it is 

 lengthened proportionately. The difference between the length 

 measurements will, therefore,, be very considerable. 



A convenient method of comparing the lengths of the lower 

 limbs can be used in children. The patient is placed on his 

 back ; and care is taken to see that the limbs are symmetrically 

 disposed and that the pelvis is not tilted. With the knees 

 extended, the thighs are semi-flexed at the hips so that the 

 soles point upwards. The relative positions of the heels are 

 at once demonstrated. 



Examination of the Hip-Joint and Proximal Ex- 

 tremity Of the Femur. The patient should be completely 

 stripped and asked to walk if possible, as the gait may be of 

 assistance in determining the diagnosis. Any limitation of 

 active movement, the presence of a limp or lurch, and the way 

 in which the feet are placed on the ground should all be observed 

 with great care. 



After this inspection the patient should be placed on his 

 back on a hard, firm surface. The bony prominences on each 

 side can then be carefully marked, and while this is being done 

 palpation and comparison of the trochanters may be carried 

 out and the position of the femoral head may be determined. 

 The measurements of both limbs are next taken and the various 

 lines (p. 424) may be utilised. 



Lastly, the extent and nature of passive movements must 

 be examined. These movements, which comprise flexion, 

 extension, abduction, adduction, circumduction, and rotation 

 are first carried out on the healthy limb in order to test their 

 normal extent and to gain the confidence of the patient. Next 

 the movement of hyperextension is tested, with the patient in 

 the prone position. The pelvis is fixed by a hand placed on the 

 sacrum ; and the other hand, placed under the thigh, hyper- 

 extends the limb by lifting it from the table. Differences in 

 the extent of symmetrically arranged passive movements, with 

 or even without differences in length measurements, are most 

 valuable in diagnosis. 



The use of radiograms has made the diagnosis of disease or 

 injury in the region of the hip-joint much more certain. 



Function of the Hip -Joint. In contradistinction to the 

 shoulder-joint, where free mobility is the first essential, the 

 chief characteristic of the hip-joint is its stability. Consequently, 

 in the treatment of pathological conditions of the joint, the chief 



