on the
ilium. When reduction is impossible by any means, a stiff leather
jacket with prolongations around the thighs may diminish the deformity
and improve the walking.

#Snapping Hip# (_Hanche a ressort_).--This is a rare affection, met
with in children and young adults, and characterised by the occurrence
of a sudden, snapping sound, sometimes attended with pain in the
region of the great trochanter. This usually occurs when the limb is
slightly flexed or adducted, and rotated either inwards or outwards.
On palpation a cord-like structure may be felt, which slips forwards
and backwards over the trochanter when the position of the limb is
altered.

The condition was formerly described as a voluntary dislocation of the
hip; it is now believed to be due to a cord-like band of tissue
slipping backwards and forwards over the trochanter. The band is
usually derived from the fascia lata, sometimes reinforced by the
anterior fibres of the gluteus maximus, sometimes by the tensor fasciae
femoris. The condition seldom gives rise to any appreciable disability
and surgical treatment is rarely called for. In a number of cases the
muscle has been fixed by sutures with satisfactory results. In a
recent case, an extensive open dissection proved negative, but the
stitching of the gluteus to the trochanter was followed by the
disappearance of the snapping.

#Paralytic Deformities of the Hip.#--In anterior poliomyelitis the
paralysis of muscles may be so widespread that the limb is unable to
support the weight of the body, or certain groups of muscles only are
paralysed and the child may be able to walk with the help of
apparatus. Even if the ilio-psoas is paralysed, flexion is still
possible by the anterior fibres of the gluteus medius, the anterior
adductors, and when the leg is rotated out by the tensor fasciae and
sartorius, the dislocation differs from the traumatic variety in that
the head, although it leaves the socket, remains within the capsule.
Dislocation tends to occur from the disturbance of muscular balance,
anterior dislocation being commoner than posterior in about the
proportion of two to one; the nature of the dislocation is best
demonstrated by means of the X-rays. Reduction is rarely possible
without an open operation. Tendon and nerve-transplantation are
scarcely possible, and arthrodesis is rarely to be recommended;
contracture deformities, however, are often benefited by tenotomy in
young children, and in old