Lectures on orthopedic surgery . lammation would make thereplacement more secure and with the desire to obtaina stiff and therefore a more stable joint. It appears tous a question whether a stiff hip is more to be desiredthan a freely movable one, though dislocated. In allcases there has been shortening of about a quarter ofan inch. The first operative work was in the way of excisionof the joint; this did not prove a success. Guerin, incases where it was found impossible to retain the head,divided the shortened muscles subcutaneously andscarified to provoke effusion of organizing
Lectures on orthopedic surgery . lammation would make thereplacement more secure and with the desire to obtaina stiff and therefore a more stable joint. It appears tous a question whether a stiff hip is more to be desiredthan a freely movable one, though dislocated. In allcases there has been shortening of about a quarter ofan inch. The first operative work was in the way of excisionof the joint; this did not prove a success. Guerin, incases where it was found impossible to retain the head,divided the shortened muscles subcutaneously andscarified to provoke effusion of organizing work was investigated by a commission fromthe Council General of the Civil Hospitals of Paris in1843, and his ciires were confirmed. This method,however, fell into disuse. The popularization of the operative treatment forcongenital dislocation of the hip is due to Hoffa, ofWiirzburg, who began this work about 10 years ago. 345 In 1891 we saw him operate, and the operation wassubstantially as follows : The patient was laid on his. Fig. 268.—Showing the same patient shown in Figs. 265, 266 and 267, one yearlater after treatment in bed by traction. The lumbar lordosis has beenovercome, as well as the flexion of the thigh, and the leg has been pulleddown to the full length. A supporting walking splint is also shown. side, the thigh flexed to a right angle, an incision fol-lowing the line of the fibers of the gluteal muscle was 346 made over and down to the joint, the capsule opened,the head of the femur turned out of the wound, allmuscular attachments to the femur were separated sub-periosteally down to the lesser trochanter, the capsulewas then followed with the finger and the acetabulumlocated, this was then enlarged with a sharp spoon ora gouge until it was large enough to easily receive thehead and deep enough to readily retain it, then the legwas straightened. Hoffa then claimed that unless theshort muscles were separated from the femur the re-placed head would be thrown out
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
