The anatomical results of treatment, from 1942 to 1950, of patients under four years old with congenital dislocation of the hip and of those with preluxation treated from 1942 to 1954 have been reviewed. Thirty-two patients with thirty-nine hip preluxations with a minimal follow-up of four years, six with seven subluxations, and fifty-eight patients with seventy-four hip dislocations and four subluxations with a minimal follow-up of eight years were included in the study. The dislocations were reduced with the child under general anaesthesia; only three open reductions were done when closed reduction failed. Rotation osteotomy was done on thirteen patients.
Good anatomical results were obtained in all cases of preluxation and subluxation (Groups I and II). Good anatomical results were also obtained in fifty-two of the dislocated hips; a dysplastic hip resulted in eleven instances. Thus, the femoral head was in a correct position in the acetabulum in sixty-three of the seventy-four dislocated hips. Moderate subluxation developed in five hips and severe subluxation in six. No redislocation occurred. Closed reduction followed by carefully supervised treatment offers satisfactory results in the majority of congenital dislocations of the hip if a child is seen before he is four years of age.
The importance of early treatment is apparent when the cases are divided into three groups. Good anatomical results were obtained in (a) all patients initially treated before the age of one year; (b) 78 per cent of patients who were one to two years of age; and (c) only 57 per cent of those who were two to four years of age. Early treatment offers the only possibility of obtaining good results almost regularly. The orthopaedic surgeon must collaborate with the pediatrician to discover all cases of congenital dislocation of the hip in early infancy. Ortolani's snapping sign is the only unequivocal sign of early dislocation.
Copyright 1959 by The Journal of Bone and Joint Surgery, Incorporated