REIDER PART 214

174_Chapter 5 Pelvis, Hip, and Thigh

A    B

Figurę 5-15. A, Simulated adduction contracture of the left hip. B, Compensation with lift under thc left foot.

the model is simulating a flexion contracture of the hips. To compensate for such an inability to fully extend the hips, a patient hypcrextcnds the lumbar spine, as demon-strated in Figurę 5-1 SC. This results in hyperlordosis, in which thc abdomen and buttocks arc morę prominent than normal. When hip flexion contractures become morę severe, the patient is unable to stand fully erect.

Rotational Malalignment

Resting Position. In the setting of acute trauma, the patient is often first encountered in the supine position. In this situation, the resting position of thc limb often alerts the clinician to thc probable diagnosis. When a posterior disheation of the hip is present, for example, the hip assumes a flexcd and internally rotated position. An exter-nal rotation deformity, on the other hand, may reflect an anterior dislocation or a fracture of the hip or femur. A vari-able amount of apparent shortening of the limb is present as well, depending on the exact naturę of the injury.

In-Toeing/Out-Toeing. In the ambulatory patient, the examiner may screen for rotational malalignment of the

Figurę 5-16. Comparing femoral lengths.

Figurę 5-17. Comparing tibial lengths.