In forty-one children who had forty-seven congenitally dislocated hips,
the results of attempted closed reduction with general anesthesia, but
without preliminary traction, were studied. Twenty (43 per cent) of the
hips could not be reduced closed, and an open reduction was needed. After
the reduction, all of the involved hips were immobilized in the so-called
human position (marked flexion and slight abduction). At a minimum
follow-up of two years, osteonecrosis of the femoral head had developed in
only two hips (4 per cent). Patients who were more than one year old when
the hip was reduced had a higher incidence of osteonecrosis of the femoral
head and were more likely to need reconstructive procedures later. Patients
who were more than eighteen months old at the time of the attempted closed
reduction were more likely to need an open reduction of the hip. Treatment
of congenital dislocation of the hip in young children remains an extremely
complex problem. It has not been clearly established that the use of
preliminary traction decreases the incidence of osteonecrosis of the
femoral head or improves the outcome of treatment. In our experience,
uncomplicated (non-teratological, postnatal) congenital dislocation of the
hip has been safely treated with either open or closed reduction without
preliminary traction in patients who were younger than two years old,
provided that the reduction could be obtained without excessive force.