Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
_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 anæsthesia, 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 anæsthetic, 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 restricted, and
with but little impairment of function. The child should be treated
for rickets, and put up in a double long splint with the limbs
abducted and inverted.
In _arthritis deformans_ of the hip, it is not uncommon to have
considerable depression of the head of the bone and diminution in the
angle of its neck, with consequent restriction of abduction. Sometimes
the upper end of the shaft is also curved.
In _osteomyelitis fibrosa_, involving the upper end of the femur, a
gross form of coxa vara may be observed, of which a marked example is
shown in figures on pp. 476, 478, Volume I.
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