CASE 1.—A child of eighteen months cannot walk well. The mother states that the child never had any pain, began to walk when fourteen months old, has a limping gait, tires easily, and appeal?, to stand mostly on one leg. On examination it is found that the child limps on the left side and that the body is inclined towards the left. The left gluteal fold is lowered. The region of the trochanter is marked for identification and a line drawn from the anterior superior spine of the ilium to the tuber osity of the ischium (Roser-Nelaton line). Oil the left side the trochanter is located above this line; on the right side below it. Grasping the femur with one hand and the pelvis with the other, one can readily feel the left femur gliding in a longitudinal direction along the pelvis. On measuring the distance from the anterior superior spine to the internal malleolus, we find a shortening of about two centimetres on the left side.
Pulsation of the femoral artery can be distinctly felt beneath the inguinal ligament on the right side, and pressure with a finger a little to the out side of this artery reveals a resistance which increases on overextending the femur and rotating it outward. This is the head of the femur. This resistance cannot be detected on the left side.
When the child walks the upward and downward displacement of the contour of the trochanter can be seen. When the child runs the limping decreases as temporary compensation takes place owing to acceleration of the movements. While standing on the left leg the pelvis is tilted downward on the right side and when standing on the right leg the pelvis is held horizontally on the left side. Diagnosis: Dislocation of the left hip.