Two Cases of Incision into the Hip-Joint, with Observations as to Distraction in Hip-Disease

1888 Boston Medical and Surgical Journal  
In the second case, a boy of four, a small quantity of thick pus was evacuated and the patient's symptoms decidedly relieved, but not until a short time after the operation. Two weeks after the operation the night cries had diminished so that they were not present, or only occasional, while before they had persisted for weeks at a rate of fourteen and fifteen cries a night. The immediate effect of the operative interference appeared not to be beneficial, and the sensitiveness of the joint was
more » ... of the joint was increased for a few days ; but as soon as drainage from the joint became well established, and compresses and pads and bandages incidental to aseptic dressings were discontinued, the night cries diminished noticeably. No difficulty was encountered in opening the joint. A straight incision was made behind the trochanter major, extending above it. After the skin and muscles were divided and separated, the forefinger was thrust down to the joint and used as a director, the capsule was reached at the upper and back part of the joint. This was opened and the opening dilated. No distension of the capsule of the joint could be felt, and but a small quantity of thick pus was evacuated. The capsule wall, however, was found to be comparatively soft. After a slight pull upon the limb the femur was pulled away from the acetabulum and the finger could be inserted between the acetabulum and the head of the femur ; both were found to be covered with granulations. No explanation could be found for the persistent night cries. The incision, etc., were done under aseptic precautions. The treatment after the operation was the same as before ; namely, fixation by means of a fixation frame, and extension by an extension splint, and at the end of three weeks the boy was allowed to walk about on his crutches, elevated shoe, and wearing his extension splint. It cannot be claimed that the amount of benefit obtained in these cases warranted the operative interference. For even in the second case perforation of the capsule and relief of the intra-capsular tension, and consequent extreme sensitiveness would have taken place spontaneously, and in all probability the drainage from the joint would have been better than that at first afforded by the incision. In the second case, however, relief of the symptoms was obtained somewhat more speedily after the incision than if left to a natural course.
doi:10.1056/nejm188808161190702 fatcat:f3kxclnjifdzlhitivg65ehwji