Abstract
Neonatal infants with Ortolani-positive dislocated hips are easily managed by reduction and maintenance of the reduction using a divarication splint, cast, or Pavlik harness. Sixty-six patients with 85 complete, congenitally dislocated hips (Ortolani negative) unassociated with other neuromuscular disorders were examined to assess a method of prereduction traction in the treatment of congenital dislocation of the hip. Forty of the 66 patients were six months of age or younger at the beginning of traction treatment. The remaining 26 were younger than 12 months of age prior to the treatment protocol. Overhead traction with the hip flexed to 90 degrees was employed. Gradual hip abduction to 70 degrees (140 degrees combined abduction) was accomplished over the next ten to 14 days. If the dislocated hip was still in a station above Hilgenreiner's line, then cross traction was applied to add another vector of force to pull the femoral head distally. At an average of 18 days into the treatment protocol, an examination under anesthesia with closed reduction was performed and the patient immobilized in a double hip spica in the "human" position for six to eight weeks. This was followed by use of an Ilfeld divarication splint for nine months. This traction/reduction program was effective in 91% of these cases (60 of 66). Six patients (ten hips) required an open procedure because of persistent instability in spite of reducibility. To date, there is no incidence of avascular necrosis using the criteria of Salter for whole head avascular necrosis and the criteria of Kalamchi and MacEwen for partial head avascular necrosis.
Highlights
Royal Whitman,[1] of New York, strongly recommends the open operation for congenital dislocation of the hip, a condition which is to be regarded as a serious and progressive deformity, and one full worthy of careful operative treatment. He thinks that the statements in recent text-books and the discussions at societies show that the gravity of the disability is not appreciated, and that the dangers of positive treatment are exaggerated
The operation which he performs isslightly modified from that of Lorenz, and is done as follows : The joint is opened by a lateral incision just below and one inch to the outer side of the anterior superior spine
This exposes the fascia, through which the line of junction between the tensor vagina fenioria and the gluteus medius muscles may be seen. When these are separated from one another the capsule of the joint is at once exposed, often covered in parts by the fibres of the ilio-psoas muscle
Summary
Dk. Royal Whitman,[1] of New York, strongly recommends the open operation for congenital dislocation of the hip, a condition which is to be regarded as a serious and progressive deformity, and one full worthy of careful operative treatment. He thinks that the statements in recent text-books and the discussions at societies show that the gravity of the disability is not appreciated, and that the dangers of positive treatment are exaggerated.
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