KÖNIG'S OPERATION IN THE TREATMENT OF CONGENITAL DISLOCATION OF THE HIP

¹ The State Institute of Traumatology and Orthopaedic Surgery, Leningrad, F. I. Mashansky, M.D., Director

1. König's operation is indicated in cases of irreducible dislocation, characterized by the absence of lordosis and "luxation planne", and presenting mobility of the femur along its axis,—cases in which both of the factors causing Trendelenburg's symptom may be observed.

2. In cases of pathological dislocation, characterized by complete deformation of the femoral head and neck, where other palliative methods of surgical treatment can hardly be expected to produce the desired effect, König's operation permits the formation of a barrier which prevents the femur from shifting along its axis.

3. In cases of paralytic dislocation in which the femoral head has been brought down and placed in the acetabulum, the ledge formed by means of König's operation serves to keep the femoral head from shifting upward.

4. In cases in which the shortening is very considerable (over four or five centimeters), owing to the bringing into close proximity of the points of origin and insertion of the gluteus medius and the gluteus minimus, the resultant loss of tonus can hardly be restored after operation; hence Trendelenburg's symptom does not completely disappear.

5. The osteoperiosteal ledge should be made as wide as possible, so that when it is turned down over the femoral head it is in the closest proximity to the upper end of the femur.

6. If possible, the ledge should be placed somewhat posterior to the dislocated femoral head to prevent the head from slipping out when the thigh is flexed.

7. The use of massage, electrization, and gymnastics in the postoperative period is of great importance in improving the function of the gluteal muscles.

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