A treatise on orthopedic surgery . y holding the j^rojecting drill, the limbis rotated outward until the normal relation between the shaftand the neck is restored. A plaster spica including the foot isthen applied, the turns being made about the drill so that out-ward rotation of the ujDper fragment is prevented. Severalweeks later, when the improved position is assured, this is with-drawn. The after-treatment is the same as in the uncompli-cated cases. The Open Operation with Enlargement of the Acetabulum.—Theoriginal Hoffa-Lorenz ojjeration, once the treatment of routine,is now reserved for
A treatise on orthopedic surgery . y holding the j^rojecting drill, the limbis rotated outward until the normal relation between the shaftand the neck is restored. A plaster spica including the foot isthen applied, the turns being made about the drill so that out-ward rotation of the ujDper fragment is prevented. Severalweeks later, when the improved position is assured, this is with-drawn. The after-treatment is the same as in the uncompli-cated cases. The Open Operation with Enlargement of the Acetabulum.—Theoriginal Hoffa-Lorenz ojjeration, once the treatment of routine,is now reserved for a restricted class of cases in which the blood-less operation has failed, or in which on opening the joint theacetabulum is found to be notablv deficient. 566 OETHOPEDIC SUEGEEY. Supposing the shortening of the limb to have been overcomebj previous treatment, the joint and capsule are opened in themanner already described. One finger is then inserted to theacetabulum and by its side a strong, sharp bayonet-shaped spoon Fig. Scoops used in the treatment of congenital dislocation, also the subcutaneous osteotome. (Fig. 375) is passed, and with it the shallow acetabulum is en-larged to a sufficient size, care being taken to accentuate its supe-rior and posterior border. The head is then placed within it,and the wound is closed or packed according to the custom ofthe operator, Hoffa, who was the principal exponent of theoperation, made an oblique incision from the anterior superiorspine downward and backward over the trochanter and exposingthe joint between the gluteus medius and minimus usually employed the Doyen instrument to bore out a verycapacious acetabulum after reposition. A long plaster spica isapjilied with the limb in an attitude of moderate abductionand extension. In a month, or when repair is complete, a shortLorenz spica is applied and the patient is encouraged to walkabout. This support should be worn for from six months to a CONGENITAL DISLOCATION
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Keywords: ., bookauthorwhitmanr, bookcentury1900, bookdecade1910, bookyear1910
