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CONGENITAL DISLOCATION OF HIP TREATED BY OPEN OPERATION A Report of Seventy-two Cases
M. BECKETT HOWORTH; HAROLD W. SMITH
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Fellows of the New York Orthopaedic Dispensary and Hospital
The Journal of Bone & Joint Surgery.  1932; 14:299-313 
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Abstract

A study of eighty-two open reductions of congenital dislocation of the hip, with a follow-up examination of seventy-two of the hips, is presented, with details of the preoperative examination and treatment, the operative findings and procedure, postoperative care, and the results several years after operation. It is definitely shown that a fairly large percentage of congenital dislocations of the hip cannot be reduced, or the reduction maintained, by closed operation because of anatomical abnormalities about the acetabulum. It is further demonstrated that roentgenograms taken with the patient standing and under traction, as well as the ordinary recumbent views, are essential for a thorough study of these hips both before and after operation. It is particularly important that the pathological condition and mechanism at the hip be carefully studied at operation. It is our practice now to study the hip at operation upon exposure of the capsule, after opening the capsule, and after removing the ligamentum teres, to determine the factors interfering with reducton and stability, and we test the stability of the hip after reduction with upward pressure on the leg during gradual adduction and in various positions of rotation. The rotation procedure is valuable in determining the necessity for correction of anteversion. Furthermore, there is so much individual variation in these hips that they cannot be grouped together indiscriminately and compared superficially in attempts to present the best apparent results. It is felt that a more definite method of comparison is required for properly evaluating the results of the operation than the usual "excellent", "good", or "fair" ("poor" rarely appears in the literature) and, for want of an accepted standard, our cases are reported in some detail and a method of evaluating motion given.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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