Frame Reduction as Compared with Manipulative Reduction

With the object of assessing the results of various methods of treatment of congenital dislocation of the hip used in this centre from 1920 to 1950, a clinical and radiographic review of all available cases was undertaken, the data being grouped according to the initial method of reduction. The results of treatment in this analysis have been assessed according to two criteria : 1) quality of the reduction ; and 2) incidence of pathological changes in the head after reduction. A method of traction and gradual abduction for the reduction of congenital dislocation of the hip was first used in this hospital in 1935 with the purpose of minimising the danger of damage to the blood supply of the femoral head during reposition. Details of this technique were published by Scott (1953). Traction was the method first used for the reduction of a congenital dislocation of the hip, when Pravaz (1 837) attempted to bring the femoral head down gradually by prolonged traction and then to manoeuvre it into the acetabulum by a combination of extension, abduction and pressure on the trochanter. Later Putti (1929) introduced his divaricator based on similar principles and Keith (1935) developed his traction frame improving on a board devised by McDonald. Forcible reduction by manipulation as described by Paci (1887) and by Lorenz (1895), who widely popularised it, and its modification by Denuc#{233}(1898) was the usual method of reduction in most hospitals, including ours, until the method of gradual reduction was developed. During the last few years a new surgical approach to the treatment of congenital dislocation of the hip was introduced in this hospital (Somerville 1953) ; the present review does not include these later cases.