The author studied the intermediate follow up results of open reduction for C. D. H. in infants in the orthopaedic clinic of Kansai Med. University. The surgical series consists of 36 hips of 31 infants. A surgical technique that we call“circular limbectomy”was used. This technique has several technical procedures and was first introduced about 8 years ago, These procedures are as follows:
1. A transverse skin incision is placed alongside the femoral crease.
2. The way of dissecting down to the hip joint is similar to the approach described by O. Aufranc, in Boston, in 1962.
3. After widely exposing the anterior surface of the hip joint, the capsule is opened by a J-shaped arthrotomy incision (in the right hip). The horizontal ramus of th i s incision is placed parallel to, and 0.5∼1 cm below, the acetabular margin.
4. After removing both ligamentum teres femoris and fibro-fatty tissue, thickened and often inverted limbus is cut in a circular fashion in the middle between its in n er and outer margins. In this way the limbus is divided into inner and outer layers and the inner layer is removed and the outer one is left behind. The lig. transversu s acetabuli is severed in order to have the medial inferior quadrant of the jo int capsule fully released so that, as a result, satisfactory space may be created for the f e moral head to be stably and concentrically held into place.
5. Before opening the capsule, the iliopsoas tendon is cut close to its insertion to the lesser trochanter. After closing the capsule, the severed end of the tendon is transplanted to the anterior inferior part of the closed capsule.
The cases followed up in the surgical series involve 31 patients, (3 males and 28females), and 36 hips among which unilateral hip involvement involves 26 hips (8 right hips and 18 left hips). The average age of the infants at the time of surgery is 1 year and 3 months. The youngest is 3 months and the oldest is 2 years and 7 months. Surgery is indicated from clinical and radiological points of view in which a plain X-ray examination as well as an arthrographic examination are used. Radiologically, with the exception of one inreduceable hip joint, all the 35 hips show eccentric positions of the femoral head which, by our circular limbectomy performance, could be reduced more accurately into the anatomical position. Detorsion osteotomy was performed only secondarily in 8 hips. The postoperative results followed up are briefly summarized as follows.
Out of 31 patients, normal gait with no limping is seen in 30 patients. Sight occasional limping with intermittent pain in walking is seen in only one. R. O. M. is almost normal in 27 patients and it is also fairly good in the rest of the 4 patients.
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