NOTES ON THE PATHOLOGICAL ANATOMY OF CONGENITAL HIP DISLOCATION

1. The condition is usually intrauterine in occurrence, relatively seldom resulting from difficult delivery.

2. Some few cases may develop progressively, where there is some deficiency of the upper lip of he acetabu'um, combined with relaxed ligaments and loss of tone in the surrounding muscles.

3. Before attempting reduction, the shape and axis of the head of the femur should be ascertained, also condition of acetabulum.

4. In young cases the radiogram may be misleading owing to the predominance of cartilage in the formation of the articulation.

5. Reduction may be carried out either over the posterior rim of the acetabulum or the inferior,, according to the experience of the operator.

6. After reduction the "range of retention" in the joint should be ascertained by redislocating and fixation adopted in the position most removed from the recurring point.

7. Malposition, especially that resulting from anteverted head, should be carefully guarded against.

8. Between fixations it is wise to control the position of the head by means of the radiogram.

9. In older cases, after six years of age, the possibility of contractures in a faulty position must be guarded against. Therefore the fixation must not be of two long duration—6 weeks to 2 months.

10. While weight-bearing may stimulate the development of the femoral head and acetabulum, it is not essential and quite contraindicated in a percentage of cases.

11. Owing to muscle changes the convalescent treatment of massage and exercises should be carefully followed until the disappearance of the Trendelenburg symptom.

12. Myorrhexis of the muscles is only occasionally essential.

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