File:A treatise on orthopedic surgery (1903) (14764615712).jpg

Identifier: treatiseonorth00whit (find matches)
Title: A treatise on orthopedic surgery
Year: 1903 (1900s)
Authors: Whitman, Royal, 1857-
Subjects:
Publisher: Philadelphia and New York, Lea brothers & co.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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Changed Relation of the Femur and Tibia. In addition to thedirect deformities of the bones there is a change in the relationof the femur to the tibia. The former is rotated inward and thelatter is rotated outward. In some instances there is also a cer-tain degree of overextension at the knee. This is more oftenobserved in the adolescent type, in which there is laxity of theLigaments (Fig. 337). In the ordinary form of rhachitic knock-knee in childhood the habitual attitude is one of slight flexion DEFORMITIES OF BOXES OF LOWER EXTREMITY. 563 at the knees, and in extreme cases there may be actual limitationof the range of extension at the knee, and at the hip as well. The Accommodative Attitude. When the limb is fully extendedthe deformity is most marked, because the shortened ligamentsand tissues on the outer aspect of the joint become tense, andbecause the outward rotation of the tibia is increased. As theleg is flexed the deformity lessens, and in the attitude of complete Fig. 338.
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Skiagram of I • ving the deformity to be due to distortions of the diaphyses of the bones, while the epiphyses are practically normal. flexion it disappears (Fig. 340). This is explained by the factthat the posterior surface of the condyles is not affected by thedeformity of the -haft, while the relaxation of the ligaments andthe outward rotation of the femora allow the tibiae to becomeparallel with one another. This accounts for the habitual atti-tude of slight flexion which is so often assumed by patients whothus unconsciously accommodate themselves to the deformity. 564 ORTHOPEDIC SURGERY. Fig. 339. Secondary Deformities. The outward inclination of the legthrows more weight upon the inner border of the foot and tendsto depress it into the attitude of valgus. Thus knock-knee inweak children is often accompanied by flat-foot, but in the more extreme grades of deformitythe efforts of the patient to com-pensate for the abnormal sepa-ration of the feet may result inhabitual supination

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