Reduction Of Hip Dislocation Research Articles

Oscar Huntington Allis

Oscar Allis was born September 9, 1836, in Holley, New York, a direct descendant of a Puritan settler with the First Salem, Massachusetts, colony. He attended Lafayette College and received a Master of Arts degree in 1864. He graduated from Jefferson Medical College in 1866. Following an internship at the Philadelphia General Hospital, he ultimately became one of the original surgeons of the Presbyterian Hospital in Philadelphia. Allis developed a particular interest in orthopedic surgery, and was a recognized authority on fractures and dislocations. In 1895 he received the Gross prize of $1000 for his monograph on reduction of hip dislocations. Relaxation of the fascia between the iliac crest and the greater trochanter, a sign of fracture of the neck of the femur, is Allis' sign. Among his many valuable contributions to surgery were his dissector, the ether inhaler, and the splint—all were named for him. Today, the Allis forceps continues to be one of the standard instruments in any general surgical kit. The paper through which this instrument was introduced is reproduced here. Like so many articles that contribute to our heritage in this Classics series, the subject is anastomotic technique as it developed in those early days. Allis died May 16, 1921, of a cerebral hemorrhage at the age of 84.

Simultaneous bilateral traumatic dislocation of the hip.

1.1. Dreaded necrosis of the caput femoris has not followed this instance of simultaneous traumatic dislocation of both hips with minor fractures of the acetabular rim. 2.2. Fractures of the acetabular rims have healed with no apparent blocking of hip joint motions up to six years after dislocation. Later changes may appear, especially in a man so athletically inclined. 3.3. When shock exists, with bilateral dislocation of the hip, one side may be reduced at a time, without too great an interval (ten days). 4.4. Aseptic necrosis of the head of the femur does not follow every hip dislocation, even when unreduced ten days. The ratio of acetabular fracture, the interference with articular circulation from tension or malposition, hemarthrosis, capsular tear or pressure and ligamentum teres laceration are all factors contributing to possible necrosis of the head of the femur. Local pressure and thrombosis seem most important to me. 5.5. There is no doubt that fragments of accompanying acetabular fracture may lead to difficulties of obtaining and holding reduction, or lead to a tendency to recurrence or subsequent restriction of joint motion. I am in accord with Dr. Urist' excellent study of this problem and believe some instances require operative fixation of the acetabular lesion. 6.6. Putting the patient in a position where one may apply one's utmost physical power under control is the wisest course in reducing dislocation of the hip. Try the floor. 7.7. Undoubtedly, prolonged rest after reduction of hip dislocation with slowly increasing active motions of the hip and long delayed weight-bearing favor a good prognosis and a minimum of new bone formation which may restrict hip motion with or without acetabular rim fracture. 8.8. A young athletic male is a wonderful bit of mechanism.