Resulting contractions may be overcome by elastic traction, yet it is better to rely more on time than on forceful manipulations. The natural desire of the child to increase the function is certainly much safer.
This describes in a general manner the bloodless method of treat ment in congenital hip dislocations in the Children's Hospital at Gratz, and it differs only in minor details from that advocated by Lorenz.
The most satisfactory age to reduce these dislocations is from one and a half to three years. The wetting and soiling of young children gives much trouble, but treatment should not be deferred on this ac count. The upper limit of age is of more importance. Secondary changes increase so rapidly that a fairly normal establishment of function seldom occurs later than the ninth or tenth year, even if the dislocation has been successfully reduced.
In bilateral dislocations the upper limit of operative procedure is reached more rapidly on account of destructive processes producing stiffening of the joint. This is due to the closing up of the unequal articulating bodies. The upper limit in these eases is from the fifth to the seventh year. The employment of new methods has occasionally resulted successfully in olcler dislocations (Becher, Reiner, Lange).
It is impossible in some cases to retain the head entirely in the acetabulum. Very often it slips out of the acetabu]um over the anterior border and remains below the anterior superior spine. The tendon of
the rect us femoris muscle passes over it and in conjunction with the spine forms a support (subluxation, transposition).
A reluxation backwards seldom occurs after treatment by the present technic.
The results are exceptionally good. There have been reported over 80 per cent. of anatomical cures. It must be borne in mind that decep tive results may occur, in that the function in transposed joints is often much better than in anatomical reposition (especially in older joints).
Changes may occur in the reduced hips as a result of the inability of the atrophied head and neck to carry the weight of the body. The acetabulum being much firmer may grind off the head and force the neck to assume a varus position (Frohlich).
The so-called bloody operation may be attempted in case reposi tion and retention are unsuccessful. This is the older method and was inaugurated by Hoffa and most of our anatomical knowledge of this condition is derived from it.
The strong forces of development during the first years of life give ample possibility to influence the growth of the tissues and change the direction in which they are growing. The results which have been attained by conservative measures prove that operations should be advocated only in exceptional cases.
Treatment by means of apparatus alone is antiquated and should be absolutely prohibited in children.