Skeletal traction vs. femoral shortening in treatment of older children with congenital hip dislocation.

A review of skeletal traction compared with femoral shortening in treatment of older patients with congenital dislocation of the hip clearly favors femoral shortening. During the period 1952-74, 30 hips in 22 patients (average age, 6 6/12 years) were treated with skeletal traction, and during 1971-77, 17 hips in 12 patients (average age, 6 8/12 years) were treated with femoral shortening. In those treated with skeletal traction, avascular necrosis developed in 57%; redislocation or subluxation in 30%; an X-ray rating (Severin) of poor in 43%; and the incidence of pin and skin complications was 27%. The average follow-up was 11 1/2 years. In the group treated with femoral shortening, there were no cases of avascular necrosis and none with a poor rating on X-ray. The average follow-up was three years and seven months and it was never less than one year. Complications included one refracture at the osteotomy site six weeks after surgery, one late resubluxation, and two redislocations (early in the series prior to routine use of Steinmann pin fixation). The redislocations were easily reduced. Acceptable leg length inequality was present in all unilateral cases except in one 12-year-old patient who required a contralateral epiphysiodesis. One patient with late subluxation had open reduction and acetabuloplasty.