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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is, which caused the deformity, but theobservations of Mikulicz and Macewen have shown that thisapparent Lengthening is in reality due in great part to a deformityof the lower extremity of the shaft of the femur, which is so bentthai the epiphyseal line has an increased obliquity. And thehypothesis that bone grows more rapidly when relieved fromweight and -train baa been disproved by Wolff, who has demou-i thai changes in the bones are the result of accommodationto altered function and attitude. (See page 235.) The deformity 562 ORTHOPEDIC SURGERY. is Dot limited to the femur ; in most instances there is a similar,although usually slighter, irregularity in the epiphyseal line ofthe upper extremity of the tibia, the shaft being so bent thatwhen it is placed in the perpendicular position its internal con-dylar surface is higher than the external. In some instances theprimary and principal deformity is of the tibia, the distortionbeing most marked in its upper third (Fig. 337). Fig. 337.
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Adolescent knock-knees. Deformity most marked in the tibiae. (See Fig. 340.) 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 thele

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