On the successful treatment of cases of congenital displacement of the hip-joint by complete recumbency with extension for two years / by William Adams.

  • Adams, William, 1820-1900.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On the successful treatment of cases of congenital displacement of the hip-joint by complete recumbency with extension for two years / by William Adams. 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.

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    hood for congenital displacement of the hip-joint, and the result must be regarded as extremely satisfactory, -when we considrr that without treatment the shortening would certainly have been not less than three inches', and it might have been four or five inches, which I have seen in several cases of unilateral displace- ment, the spinal curvature and tilting of the pelvis resulting in a proportionate degree. This case sufficiently proves the great ad- vantages of the treatment I have recommended. It is remarkable that for this valuable illustration we are in- debted to an error of diagnosis, upon which the treatment was, as it were, accidentally carried out. In my own cases, when undertaken at an early age, and the treatment extended over two or three years, the ultimate result cannot fail to be good; but some permanent defect—partly due to the malformation, and partly to the subsequent changes in the head and neck of the femur—must remain; and after the comple- tion of growth, say at 20 years of age, there will probably be only about half an inch of shortening, or perhaps from that to one inch in some cases; but this result I should consider to be very satis- factory. Because absolute perfection is not to be reached, and a new hip-joint made, that is no reason why the consecutive defor- mities, which invariably result when these cases are left to Nature, should not be reduced to the minimum point, with a life- long benefit to the patient. On the Intermediate or Halfway Treatment. I have frequently been asked whether anything could be done to diminish the resulting deformity in these cases when the whole treatment, according to the programme above laid down, either cannot be carried out, or is objected to by the parents, either from a fear of injury to the general health or some other cause. The answer is that although a halfway treatment can only end in a halfway result, still by adopting the following rules much may be done to diminish the consecutive deformity, either in a case of single or double displacement. When one hip-joint only is affected 1. Weight extension must be employed during the night, and part of the day, when the child is reclining on a sofa, say four to six hours, about two hours each time. The extension apparatus for this is simple enough, and such as is usually employed in cases of hip-joint disease. 2. The child may be allowed to walk about in the intervals of reclining, if old enough to use crutches, and then a raised boot of one inch and a half must be worn on the sound limb, the foot of the affected limb not being allowed to touch the ground. The affected limb will however swing backwards and forwards, and its own weight will to some extent act as an extending force. This can be carried out by the poorest class of patients. Another method of locomotion, when a little expense is not objected to and more attention can be given, is by means of the splint or apparatus, which Mr Ernst has constructed for these cases, somewhat resembling the American hip-joint instrument, which combines extension with motion, and crutches are avoided, except perhaps to start with. The child usually gets along very well with one or two sticks. The raised boot is of course neces- sary on the sound limb when this apparatus is used, and an iron ring-patten on the foot of the affected limb, the boot being attached to the ring by straps, and the extension made by a rack- and-pinion movement in the side steel. The pelvic belt with pad placed above the great trochanter should also be used.