American practice of surgery : a complete system of the science and art of surgery . s should be worn a long time to allow the adhesions, etc., to form in the new attitude and thus prevent recurrence. The patient, of course, is allowed to walk with the use of crutches. Instead of the forcible manipu-lation and the application of aspica, a scheme sometimes used isthe employment of an abductionbrace (Figs. 284 and 285). Thisconsists of an inside bar endingbelow in the ordinary foot-pieceand straps described in the otherambulatory braces, and above ina perineal crutch which fits intothe junction
American practice of surgery : a complete system of the science and art of surgery . s should be worn a long time to allow the adhesions, etc., to form in the new attitude and thus prevent recurrence. The patient, of course, is allowed to walk with the use of crutches. Instead of the forcible manipu-lation and the application of aspica, a scheme sometimes used isthe employment of an abductionbrace (Figs. 284 and 285). Thisconsists of an inside bar endingbelow in the ordinary foot-pieceand straps described in the otherambulatory braces, and above ina perineal crutch which fits intothe junction of the thigh and peri-neum on the side opposite to thediseased hip. This crutch is pad-ded carefully to prevent upright bar is made in theform of a tube and is extensibleby means of a ratchet and key. When the brace is applied and the tractionstraps have been tightened by extending the inside bar with the key, the legis forcibly abducted owing to the slight angle between the leg and the bar ofthe brace. A high shoe is put on the other foot, and the patient is allowed. Fig. 283.—Fixed Deformity in Tuberculous Hip-jointDisease. Ankylosis has occurred and the thigh isflexed and adducted, with outward rotation. (Original.) 676 AMERICAN PRACTICE OF SURGERY. to walk. By tightening up the traction each day, very resistant adductiondeformity can be sometimes overcome, and, if the brace is worn sufficientlylong, it will not recur. In cases where there is upward displacement of the femur, the head havingbeen absorbed or dislocated, or where there is an ankylosis too strong to he broken down by manipulation, theonly treatment of value is subtrochan-teric osteotomy. If the deformityis reduced by . forcible manipula-tion it invariably recurs on accountof the absence of the outward lever-age of the neck of the femur and miaccount of the contraction of the pow-erful adductors which are left unbal-anced owing to the mechanical ob-struction offered to abduction by theproximity of
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