bend of the neck, the head sinking to, or even below,
the level of the great trochanter (Fig. 132); or this may be combined
with a curve of the neck, of which the convexity is upwards and
forwards, so that the lower border of the neck is greatly shortened
and the head approximated to the lesser trochanter. At the same time
the shaft of the femur is adducted and rotated outwards.

[Illustration: FIG. 132.--Rachitic Coxa Vara.

(Sir Robert Jones' case. Radiogram by Dr. Morgan.)]

_Adolescent Coxa Vara._--This, the most common clinical type, is met
with in boys between the ages of twelve and eighteen. The _unilateral_
form is nearly always the result of injury to the neck of the femur or
to the epiphysial junction, although the deformity may not show itself
for months or a year or two after the injury. The deformity may be the
first indication, or it is preceded by pain and stiffness; the patient
complains of being easily tired, of difficulty in kneeling and
sitting, difficulty in riding, and of an increasing limp in walking.
On examination, the limb is found to be shortened, the great
trochanter is displaced upwards and backwards and is unduly prominent,
and the muscles of the buttock and thigh are a little smaller and
softer than on the normal side. The limb is adducted, its normal range
of abduction, and sometimes also of flexion, is restricted, and there
is, as a rule, some degree of lateral rotation, so that the toes point
outwards. It should be noted that the same picture--shortening with
eversion and stiffness at the hip--results from the common fracture of
the neck of the bone in old people. The adduction element of the
deformity is partly compensated for by upward tilting of the pelvis on
the affected side and curvature of the spine with its concavity
towards the affected limb.

_When the condition is bilateral_ it is usually the result of disease
in the bone, rickets most frequently in this country. The attitude and
gait are highly characteristic, as the adducted and everted legs tend
to cross each other at the knee, the deformity being of the
scissors-like type (Fig. 134), and in extreme cases the patient is
only able to walk with the aid of crutches.

_Diagnosis._--Pain in the hip and a limp in walking suggest _hip-joint
disease_, but while in coxa vara the movements are chiefly restricted
in the direction of abduction, in hip disease they are restricted or
absent in all directions. From _congenital dislo