Treatment of congenital dislocation of the hip / by E.C Bradford.

  • Bradford, Edward H. (Edward Hickling), 1848-1926.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of congenital dislocation of the hip / by E.C Bradford. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    10/20 (page 4)
    4 During the operation, which was conducted with the usual care, according to the steps mentioned by Hoffa, it was impos- sible to draw the head down as far as the Nelaton line. The finger was inserted, and a point found where the acetabulum should be as far as could be determined by touch, and this was curetted and drilled out, forming, as was thought, an acetabulum of sufficient depth. It was impossible by any form of traction to bring the trochanter lower than was done. Although all the muscles had been divided and removed, it was impossible to pull the femur into its normal position. Re- duction was possible by manipulation,—i.e., flexion and rotation ; but dislocation occurred if an attempt was made to straighten the femur from the flexed position which it takes if the head is put into the acetabulum. The specimen shows that the obstacle is clearly the anterior and strongest fibres of the capsular ligament. On the side not operated upon, it is impossible to reduce the dis- location by any method, either by traction or manipulation. The specimen also shows that although the curette was used at a point which at operation appeared to be the proper position, yet it did not enlarge the normal acetabulum, but was at a consider- able distance above this place. (Fig. 2.) It would also appear that Kirmisson is correct in claiming that facts do not support Hoffa’s belief that the portion of the ilium in congenital dislocation, that it is desirable to curette for the deepened acetabulum, is the thickest portion of the ilium. This was not found to be the case in any of the four specimens at the Warren Museum in Boston. The clinical experience which the writer has had personally in the treatment of this deformity may be stated briefly as follows : One case. Aged six. Treatment by mechanical means,—viz., the use of an ambulatory traction appliance which was worn for two years, showed no change in the deformity. One case. Aged three. Treatment by an attempt at forcible reduction under ether without success. Three cases. Treatment by recumbency and traction for a long period.