To date, skeletal traction has been used as a preliminary procedure to either open or closed reduction in twenty-seven children under the age of seven years with posterior congenital dislocation of the hip. In eleven cases the deformity was bilateral, making a total of thirty-eight hips treated. (SEE FIGURES FIG. 7-A FIG. 7-B IN SOURCE PDF)
There have been twenty-nine spontaneous closed reductions without anaesthesia and nine open reductions, whereas, previous to the use of skeletal traction, 80 per cent. of the writer's cases in children under seven (SEE FIGURES IN SOURCE PDF) years were treated by open operation. The acetabulum has been reconstructed in fifteen instances, purposely not reconstructed in four instances, and should have been reconstructed in three additional cases. (SEE FIG. 9-A FIG. 9-B IN SOURCE PDF) (SEE FIGURES FIG. 10-A FIG. 10-B IN SOURCE PDF) (SEE FIGURES FIG. l1-A FIG. 11-B FIG. 11-C IN SOURCE PDF) Therefore, of the thirty-eight hips, only sixteen had an adequate acetabulum.
Femoral torsion has been corrected in twenty-eight instances and purposely not corrected in five. Consequently, there were only five cases in which femoral torsion was not present in sufficient degree to warrant operative correction.
There are now five cases in which the hip is still in plaster. In each case the reduction is satisfactory, the acetabulum is adequate, and the femoral torsion is either corrected or to be corrected. If past results can be relied upon, these patients should have entirely satisfactory end results, but, because this fact cannot be predicted with certainty, these five cases are not included in the analysis of the results.
Neither is it fair to include the five cases in which femoral torsion, inadequate acetabula, or both, were purpose1y not corrected. The five hips so treated proved to the writer's satisfaction that femoral torsion of any appreciable degree will not correct itself, and that an inadequate acetabulum will not deepen sufficiently under weight-bearing.
Of the remaining twenty-eight cases, there are twenty-five with entirely satisfactory anatomical results,-in each case the head is well within the acetabular cavity, the acetabulum is adequate, and the angle of the neck of the femur is practically normal. There are three cases in which reduction is adequate and no torsion exists, but in which the acetabulum is of the borderline type. Functionally these three hips are still excellent, but each should have an acetabular reconstruction to prevent another later upward subluxation of the head. (SEE FIG. 11-D IN SOURCE PDF) (SEE FIGURES FIG. 12-A FIG. 12-B IN SOURCE PDF) (SEE FIGURE FIG. 12-D IN SOURCE PDF)
In analyzing these hips from a purely functional standpoint, there are twenty-six with satisfactory results,-a free range of painless motion, no Trendelenburg sign, and no limp. In the other two hips there is some residual limitation of motion, but in neither is the limitation of sufficient degree to cause a limp, nor is there a Trendelenburg sign or shortening. Both cases show flexion to 90 degrees, abduction to from 40 to 60 degrees, and about half the normal amount of internal and external rotation. It is most interesting to note that both of these cases with some restriction of hip motion fall into the open-reduction and acetabular-reconstruction group.
(C) 1939 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.