er children by osteotomy through the
trochanter, and putting the limb up in the abducted position.

In _spastic paralysis_ of cerebral origin, the tendency is towards
contracture, usually in the attitude of flexion, with adduction and
inversion. This may result in dislocation backwards on to the dorsum
ilii, and may occur in patients confined to bed (Fig. 131).

[Illustration: FIG. 131.--Contracture Deformities of Upper and Lower
Limbs resulting from Spastic Cerebral Palsy in infancy.

(Photograph taken after death by Dr. Thomson of Norwich.)]

#Contractures and Ankyloses of the Hip.#--Various forms of contracture
are met with as a result of cicatricial contraction, or from
shortening of the fasciae, muscles, and ligaments when the hip has been
maintained in the flexed position for long periods--for example, in
psoas abscess, chronic rheumatism, or hysteria. The majority, however,
result from tuberculous disease of the hip-joint. In osseous
ankylosis, an attempt may be made to restore movement by the operation
of Murphy, which consists in chiselling through the osseous junction
between the bones, deepening the acetabulum if necessary, and then
interposing between the bony surfaces a portion of fat-bearing fascia
derived from the fascia lata over the great trochanter. The operation
of Jones consists in detaching the great trochanter (the insertions of
the glutei into it being left intact), dividing the neck of the femur,
and then securing the separated portion of the trochanter to the
proximal end of the neck to prevent union of the fragments.

COXA VARA AND COXA VALGA

These deformities depend on abnormalities of the angle of the neck of
the femur; the average or normal elevation is 125 deg. for the adult and
135 deg. for the child; variations between 120 deg. and 140 deg. are considered
normal. If the angle is less than 120 deg. the condition is one of coxa
vara; if greater than 140 deg., coxa valga. The angle of inclination of
the neck of the femur is dependent upon the adjustment of certain
forces, namely, the weight of the body, the action of muscles, and the
resistance of the bone. The most obvious cause of deviation of the
neck from the normal angle is some condition which causes softening
of the bone so that it yields under weight-pressure, the most common
being partial fractures, rickets, and other diseases of the bone.

#Coxa Vara--Incurvation of the Neck of the Femur.#--There may be a
simple adduction