OPEN REDUCTION OF AN OLD CONGENITAL HIP DISLOCATION

The difficulty in reducing a congenital dislocation of the hip-joint increases with the age of the patient. The chief difficulty in reducing a luxation by the closed method is the inability of passing the head of the femur through the narrow neck of the capsule. This has been recently emphasized by Galloway. When the head is once reduced it can be retained by the usual method. In older individuals the depth of the acetabular cavity and shape of the head of the femur are not the chief considerations for a successful reduction. Shortness of the soft structure, muscles, nerves, and blood-vessels are great obstacles. At the age of fifteen or twenty, the muscles, nerves, and blood-vessels have become normal for that individual, and to overcome shortening of four or five inches is a great task. It is therefore necessary to sacrifice muscular attachments. In performing this operation one should first inject the sacral canal to overcome the distressing pain from nerve stretching. One must also take particular care not to injure the blood-vessels. In our case there was no evidence of circulatory disturbance.

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