. Les maladies de l'enfance : services médicaux et chirurgicaux. omthe l'extrémité supérieure du fémur à la malléole latérale oneach-est souvent dérisoire, et sometimesthere est zéro, alors que le raccourcissement de l'asmeasured pratique bassin de la malléole isconsiderable. Si certains le shortening entraînera nécessairement, toute grande quantité est en raison du poids étant supportés sur thelimb prématurément. On a déjà signalé que la croissance en longueur des thefemur a lieu presque entièrement à sa ligne epiphysial inférieur ; d'où la longueur ou le raccourcissement lossof vrai est que la distance de la ligne de l'article au dessus de l'il

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. The diseases of children : medical and surgical. omthe upper end of the femur to the malleolus oneach side—is often trifling, and sometimesthere is none, while the practical shortening asmeasured from the pelvis to the malleolus isconsiderable. Though some shortening will necessarily result, any large amount is due to weight being borne upon thelimb prematurely. It has already been pointed out that growth in length of thefemur takes place almost entirely at its lower epiphysial line ; hence the lossof length or true shortening is only the distance from the line of section tothe top of the head, coupled with such arrest of growth as maj result fromimpaired nutrition, this last being, of course, a very inconstant quantity.Oilier estimates that during the first four years of life growth takes place aboutequally at each end of the femur ; after that time the lower end grows morerapidly. The primary objects of the operation of excision of the hip are to savelife and relieve pain ; the next most important question is that of the useful-. Fig. 165.— From a photographshowing a good average resultafter excision, when the leg hasbeen walked upon, and thestump of the femur is thrustup upon the dorsum ilii. yio Hip Disease ness of the limb and of the condition of the joint after the operation. Oneof two results must occur after excision : either a freely movable limb, or onewith varying degrees of stiffness, from some mobility to bony ankylosis.Bony ankylosis after excision is very rare. Close fibrous union, so that butlittle mobihty remains, is very common ; movement through from 30° to 50°is perhaps the commonest result, and a smaller number have completemobility. It is not possible to estimate in figures the results to be expected fromexcision ; for details we must refer to the monograph mentioned at thebeginning of the chapter. Whether, then, we consider the pathology of the disease, the actual localcondition, the relief of pain, the preservation of life, the durati

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