Content
Fragment from the article: Groves EH. Some contribution to the reconstruction
surgery of the hip (1926). The author proposes fixation of the femoral head by
creating a ligamentum capitis femoris (LCF) from the joint capsule during
reduction of congenital hip dislocation. The text in Russian is available at
the following link: 1926HeyGrovesEH.
Quote, pp. 1056-1057.
Congenital Dislocation of the Hip.
It is now generally recognized that early cases of congenital dislocation
of the hip can be efficiently treated and cured by manipulation. But it is not realised
that in older children when manipulative reduction is impossible, a great deal
can still be done by open operation to get firm and useful hip-joints. It is worse
than useless to use elaborate and difficult methods of manipulative reduction
in these older cases. The main obstacle to reduction is the tight constriction
of the capsule (Fig. 6). No force or cunning can compel the head of the femur
measuring 1 in. in diameter to pass through a thick constricted capsule
presenting a channel of about 1/4 in.
Open exposure of the joint through an anterior incision makes it quite
easy to reduce the dislocation after the constricted capsule has been slit
open. The problem then arises as to the best methods of retaining the femur in
its socket. In one method the acetabulum is deepened (Fig. 7), until it affords
a socket sufficient to take the whole femoral head. This gives a very secure
joint but one which is liable to become stiff. In another method, that which
has been most frequently used, the cartilage of the acetabulum is left
undisturbed and a new rim is added to the socket by turning down a part of the
outer surface of the iliac bone (Fig. 8). In a third method the capsule is cut
from its attachment to the pelvis and tied round the head of the femur, the
acetabulum is gouged out, the head of the bone wrapped in the capsule is placed
in the socket and anchored there by stitches which fix the capsule to the floor
of the acetabulum (Fig. 9).
In the late or adult cases of congenital dislocation a great deal can be done to cure both the pain and the lameness by a subtrochanteric osteotomy, putting up the leg in full abduction. But this is only suitable for unilateral cases. When the dislocation is bilateral, the head of one femur can be brought down into the socket by removing about 2 in. of the shaft of the bone below the small trochanter. This will give a firm hip on one side and the two legs will be of the same length. At a later date, if necessary, an osteotomy may be done on the opposite side.
Groves EH. Some contribution to the reconstruction surgery of the hip. The Lancet. 1926;208(5386)1055-7. thelancet.com , sciencedirect.com
Ernest William
Hey Grove (1872–1944) was a MSc, FRCS, Professor of Surgery at the
University of Bristol. wikipedia.org
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, plastic surgery, reconstruction, congenital dislocation, pathology
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