A STUDY OF SUBTROCHANTERIC OSTEOTOMY

¹ New York Orthopaedic Dispensary and Hospital, New York, N. Y.

From an analysis of 100 consecutive cases of subtrochanteric osteotomy the following recommendations are made:

1. The ideal position in cases of fused hips is that of 25 degrees of flexion, neutral lateral position, and neutral rotation. Patients whose hips are fused in the above position have the best gaits, and do not complain while sitting, standing, or walking. In those cases where the shortening is more than one and one-half inches, 5 to 10 degrees of abduction is recommended.

2. A high curved subtrochanteric osteotomy is recommended to correct deformities at the hip joint when operation on bone is indicated. Abduction, adduction, flexion, and rotation can be readily corrected without sacrificing leg length.

3. The position desired to produce a successful result can be obtained by attention to detail. When the osteotomy has been performed, the opposite hip should be flexed, flattening the lumbar spine. The extremity should be held in the desired position, with the aid of assistants if necessary, until the fragments are immobilized in plaster. The operator should use a goniometer, if he is not satisfied with his clinical estimate of position.

4. The difficulty of immobilizing the pelvis is recognized. A snugly fitting double plaster-of-Paris spica, extending well above the nipples, is necessary. The opposite hip should be in abduction.

5. When a subtrochanteric osteotomy is done in the presence of a mobile hip, the use of the Roger Anderson pin apparatus or skeletal traction may be of assistance to the operator in controlling the fragments. The Roger Anderson apparatus should not be used unless the operator is trained in the technique, and is aware of the attendant dangers.

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