l
marked, the child is kept in bed and the limb is extended with a
weight and pulley.

_Extension by Weight and Pulley_ (Fig. 116).--The weight employed
varies from one to four pounds in children, to ten or more pounds in
adolescents and adults, and must be adjusted to meet the requirements
of each case. If pain returns after having been relieved, it is due to
stretching of the ligaments, and the weight should be diminished or
removed for a time. If there is deformity, the line of traction should
be in the axis of the displaced limb until the deformity is got rid
of. The extension should be continued until pain, tenderness, and
muscular contraction have disappeared, and the limb has been brought
into the desired attitude.

[Illustration: FIG. 116.--Extension by adhesive plaster and Weight and
Pulley.]

In restless children, in addition to the extension, a long splint is
applied on the sound side and a sand-bag on the affected one; or,
better still, a double long splint and cross-bar, the long splint on
the affected side being furnished with a hinge opposite the hip to
permit of varying the degree of abduction (Fig. 117).

[Illustration: FIG. 117.--Stiles' Double Long Splint to admit of
abduction of diseased limb.]

When the deformed attitude does not yield rapidly to extension, it
should be corrected under an anaesthetic, and if the adductor tendons
and fasciae are so contracted that this is difficult, they should be
forcibly stretched or divided.

The immediate correction of deformed attitudes under anaesthesia has
largely replaced the more gradual method by extension with weight and
pulley; and in hospital practice it is usually followed by the
application of a plaster case. The plaster bandages are applied over a
pair of knitted drawers; the pelvis and both thighs, the diseased one
in the abducted position, are included. The case may be strengthened
by strips of aluminium, and should be renewed every six weeks or two
months.

_Ambulant Treatment._--When the patient is able to use crutches, the
affected limb is prevented from touching the ground by fixing a patten
on the sole of the boot on the sound side. This may suffice, or, in
addition, the hip-joint is kept rigid by a Thomas' (Fig. 118) or a
Taylor's splint. The Thomas' splint must be fitted to the patient
under the supervision of the surgeon, who must make himself familiar
with the construction of the splint, and its alteration by means of
wrenches.