A treatise on orthopedic surgery . bility ofthe joint at the time of reduction. In the treatment of veryyoung children, when in testing the stability at the time of 556 OBTHOPEBIC SUEGEBY. operation the femur is not displaced, even when the normalposition is approached, the limb mav be fixed by the plaster ina less distorted attitude—what Lorenz calls the indifferent posi-tion of flexion, abduction, and outward rotation. So, also, when the tests at the operation show fair stability asecond bandage need not be applied after a preliminary reten-tion of from six months, or even a much shorter tim
A treatise on orthopedic surgery . bility ofthe joint at the time of reduction. In the treatment of veryyoung children, when in testing the stability at the time of 556 OBTHOPEBIC SUEGEBY. operation the femur is not displaced, even when the normalposition is approached, the limb mav be fixed by the plaster ina less distorted attitude—what Lorenz calls the indifferent posi-tion of flexion, abduction, and outward rotation. So, also, when the tests at the operation show fair stability asecond bandage need not be applied after a preliminary reten-tion of from six months, or even a much shorter time if propersupervision can be provided, but it is better to err on the sideof safety in the matter of fixation. When the retention bandage is finally removed the attitudeof moderate abduction and outward rotation persists for a time,in some instances for several months. This being an indicationof stability, is considered a favorable sign, and no attempt ismade to correct it. If, on the other hand, as in the older class Fig. Illustrating the limitation of the range of abduction in the attitude of rightangular flexion in bilateral dislocation. of patients, the fixed abduction persists the patient should beanaesthetized and the contracted tissues carefully stretched. Inmany cases of this character the cause of the distortion is a par-tial pubic displacement, the head of the bone forming a well-marked projection beneath the femoral artery. This projectionmay be reduced by flexing the limb, and in certain instances it maybe well to fix the limb for a time in a slightly flexed position untilthe tendency toward the anterior displacement is lessened. Inthe after-treatment the limb is massaged, particularly the pos-terior and lateral muscles of the hip, and the child is encouragedto abduct and to extend the thigh, and bearing the weight on CONGENITAL DISLOCATION OF HIP AND COXA VABA. 557 the operated limb to sway the other limb laterally to the ex-treme limit. Passive movements
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