cation of the hip_
the diagnosis can usually be made by the history, the examination of
the joint and of its movements; and by the Trendelenburg test (p.
252). In _sacro-iliac disease_, the pain and tenderness are over the
sacro-iliac joint and the movements at the hip are free in all
directions. Valuable evidence is obtained from skiagrams.

_Treatment._--In the early stages, especially if there is pain and
tenderness, the patient must lie up and extension is applied in the
abducted position of the limb; after a fortnight or so recourse is had
to massage and exercises and the patient is allowed up for a little
each day, attention being paid to flat-foot, which is a common
accompaniment. When deformity is the prominent feature and interferes
with locomotion it must be corrected. The bloodless method is to be
preferred; under general anaesthesia, the shortened adductors are
stretched or divided, and forcible movements are carried out in all
directions, until the limb can be brought into an attitude of marked
abduction and internal rotation. A plaster-case is then applied, from
the pelvis to the middle of the calf, the knee being slightly flexed
for greater comfort; in a week or so the patient is able to go about,
and in a couple of months a second plaster-case is applied, this time
leaving the knee free. After another six weeks or so a moulded splint
is used, which can be removed at bedtime. The traumatic forms can
nearly always be corrected by this bloodless method. In advanced cases
the deformity can only be corrected by open operation, which consists
in dividing the femur obliquely downwards and medially through the
great trochanter, and, the adductor muscles having been ruptured or
divided, the limb is put up in the abducted position along with, if
required, powerful weight extension.

[Illustration: FIG. 133.--Coxa Vara, showing adduction curvature of
neck of femur associated with arthritis of the hip and knee.]

[Illustration: FIG. 134.--Bilateral Coxa Vara, showing scissors-leg
deformity.]

In cases of traumatic origin--epiphysial separation--Sprengel has
obtained good results by forcibly abducting and internally rotating
the limb under an anaesthetic, and then applying a plaster-case which
extends down to the knee.

#Other Forms of Coxa Vara.#--In _rickety children_, coxa vara is most
often associated with pronounced eversion of both lower extremities,
without the capacity for abduction being necessarily re