Abstract
Narugo National Hospital was entrusted with the early examination of congenital dislocation of the hip in infancy in thee service area of Iwadeyama Health Office. After the examination, we treated most of the infant that were pronounced necessary to receive medical treatment. Riemenbügel Method using a Pavlik's belt splint accounted at that time for 70 per cent of all positive treatment, and the results with this method constitute the subject of this paper.
Congenital dislocation of the hip was classified as follows: dysplasia if the acetabular index α≥30 and Iino's index, representing lateralisation of the femoral head, α<55, su, bluxation if 57>α≥55, and luxation if α>57, With these criteria, 42 of a total of 138 joints subjected to the above treatment were dislocated, 28 were subluxated and 68 were dysplastic.
The patient's age at which treatment was started was from two months to ten months old; mostly being within the range between three and six months. The procedure of the treatment generally followed the original method of Pavlik, but, in the case of anticipated lateralisation of the femoral head, we tried to apply a fixing canvas-splint.
The results were as follows: The anatomical healing was attained in 85 per cent of the cases. The abnormal change of the femoral head was revealed in 3 per cent, although so-called Perthes-like change of the femoral head was identified in only one of these cases. Lateralisation of the femoral head was suspected in 10 per cent of the cases on gross inspection of X-ray films, but a definite lateralisation with an Iino's index exceeding the maximum normal limit was found in only one joint. Of the dislocated or subluxated cases, 4.3 per cent failed to obtain spontaneous reduction.
We noted from our experience and other authors' reports that Pavlik's belt-splint method showed really a high-rate spontaneous reduction of the dislocated or subluxated hips, and that this method brought about less disturbance of the femoral head than the did other methods, although the results of treatment might depend on the age of the patient and on the grade of dislocation. In addition, we found that the tendency of the femoral head toward lateraiisation, an untoward result of the treatment, could be lessened by use of a fixing canvas-splint.
These results allow us to conclude that nowadays early examination of congenital dislocation of the hip in infancy has spread so far that we may put this method to practical use for early treatment of the congenital hip-dislocation, although various questions such as possibilities of spontaneous healing and interpretation of indication for treatment remain unsettled.
