Primary anterior congenital dislocation of the hip does exist as a true clinical entity. The findings are such that it can be accurately differentiated from the more common posterior dislocations or the simple upward subluxations. Each of the ten cases reported has presented the following cardinal characteristics:
1. Lumbar lordosis is absent.
2. There is less shortening in such individuals than is usually seen in the other two types.
3. The buttock on the affected side is flatter than normal.
4. A bulge is present anteriorly just below the anterior superior spine, marking the position of the femoral head, which can often be outlined visually.
5. The femoral head can be felt pointing directly forward just below the anterior superior spine.
6. Lateral roentgenograms of the pelvis reveal a true anterior position.
7. All anterior dislocations have recurred following closed reduction, even when preceded by preliminary skeletal traction.
The treatment now being used in these cases consists of preliminary skeletal traction followed by attempted closed reduction; if this is successful, the torsion is corrected by supracondylar osteotomy. In our experience, however, the anterior dislocations have invariably recurred after weight-bearing was instituted. Preliminary skeletal traction is again used, and, at open operation, an attempt is made to reduce the femoral head, although this is usually impossible. In either instance, a wide shelf of bone is placed extracapsularly above the femoral head along the superior rim of the acetabulum, extending forward to include the anterior superior spine. In this way adequate stability is assured even though reduction is not possible or does not persist. Results in these cases have been entirely satisfactory up to the present time, although no case has been followed longer than one year after removal of the final plaster.
(C) 1939 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.