Cases of acute traumatic synovitis, if seen at once, and given absolute and com plete rest, almost always recover per fectly.
Cases of acute, infectious osteomyeli tis demand prompt operation and re moval of diseased foci. If this can be done before too much general systemic infection has taken place, prompt recov ery usually follows.
In tubercular cases, seen early, recov ery, as a general thing, takes place. The time which a patient will have to wear a splint is very seldom under two years. If the patient is able to dispense with it inside of this time, it is remarkably fortunate, and the parent should not be led to anticipate such a result. The amount of shortening which may take place, and the amount of impairment of motion, cannot always be accurately de termined beforehand, and it is very un safe to make a definite prognosis. Cases may be seen at apparently the same time after the onset of the first sypmtoms, with apparently the same amount of dis ease, be treated in precisely similar man ner, and while one recovers with an ab solutely-perfect joint at the end of two years, the other may drag on a tedious course of four, five, or six years, and at the end of that time recover with decided shortening and marked diminution of motion. The only difference in the two eases apparently having been the per sonal equation of power to resist disease. What can be promised is that, if the patient's recuperative force is sufficient to allow it to recover at all, it can re cover with a leg parallel with its fellow, and not flexed upon the trunk. And the parents may be told that the length of time during which a splint will probably have to be employed will not be less than two years.
The question of abscess also comes into the prognosis, and parents are fre quently anxious to know whether or not a child will have an abscess. In many cases there is felt at the time of first ex amination a brawny, porky induration around the hip-joint, which is the fore runner of an abscess, or the child may be found with an inflamed, sensitive joint which absolutely precludes any possibil ity of motion, and in such cases it is quite probable that an abscess will develop more or less speedily. In other cases,
where the patient is seen early, and the brawny induration is as yet not present, no definite prognosis can be given, though the percentage of cases that de velop abscesses when thorough treat ment is carried out from an early stage of disease is decidedly small.
Treatment.—The indications for treat ment in disease of the hip-joint are, pri marily, to give the joint physiological rest, and, secondarily, if the general con dition of the patient demands special treatment, to counteract syphilis, rheu matism, and so forth, to take such meas ures as seem demanded.
To obtain rest of a joint like the hip is not easy. The Thomas hip-splint en deavors to secure it by flying the trunk and lower extremity by means of an iron bar three-fourths of an inch by three sixteenth of an inch and long enough to extend from the scapula to the lower third of the calf and fitted with cross bars long enough to embrace three fourths of the circumference of that part of the body where they are placed, namely: at the thorax, calf, and upper third of the thigh. The splint is padded with felt covered with leather and bent to fit the contour of the body in its de formed position, and then bandaged firmly to it. In acute synovitis of the hip it is an excellent means of treatment, and in cases where no other form of treat ment is practicable and capable of doing much good. The fixation which it gives the hip, however, does not counteract the reflex muscular spasm which in chronic joint-disease creates so much of the de struction which is seen in cases left to Nature, and which is capable, in cases which have been simply prevented from having flexion but not treated with trac tion, of causing perforation of the ace tabulum.
Traction in the proper line and of sufficient amount to relieve involuntary muscular spasm and so lessen intra articular pressure is the best agent we possess for relieving pain in chronic joint-disease and should always be added to any apparatus that is employed for securing fixation, as the latter, unless thus supplemented, but partially fulfills its mission.