The value of preliminary traction in the treatment of congenital dislocation of the hip.

In forty-one children who had forty-seven congenitally dislocated hips, the results of attempted closed reduction with general anesthesia, but without preliminary traction, were studied. Twenty (43 per cent) of the hips could not be reduced closed, and an open reduction was needed. After the reduction, all of the involved hips were immobilized in the so-called human position (marked flexion and slight abduction). At a minimum follow-up of two years, osteonecrosis of the femoral head had developed in only two hips (4 per cent). Patients who were more than one year old when the hip was reduced had a higher incidence of osteonecrosis of the femoral head and were more likely to need reconstructive procedures later. Patients who were more than eighteen months old at the time of the attempted closed reduction were more likely to need an open reduction of the hip. Treatment of congenital dislocation of the hip in young children remains an extremely complex problem. It has not been clearly established that the use of preliminary traction decreases the incidence of osteonecrosis of the femoral head or improves the outcome of treatment. In our experience, uncomplicated (non-teratological, postnatal) congenital dislocation of the hip has been safely treated with either open or closed reduction without preliminary traction in patients who were younger than two years old, provided that the reduction could be obtained without excessive force.