Fig. 116.—Extension by adhesive plaster and Weight and Pulley.
In restless children, in addition to the extension, a long splint is applied on the sound side and a sand-bag on the affected one; or, better still, a double long splint and cross-bar, the long splint on the affected side being furnished with a hinge opposite the hip to permit of varying the degree of abduction ([Fig. 117]).
Fig. 117.—Stiles' Double Long Splint to admit of abduction of diseased limb.
When the deformed attitude does not yield rapidly to extension, it should be corrected under an anæsthetic, and if the adductor tendons and fasciæ are so contracted that this is difficult, they should be forcibly stretched or divided.
The immediate correction of deformed attitudes under anæsthesia has largely replaced the more gradual method by extension with weight and pulley; and in hospital practice it is usually followed by the application of a plaster case. The plaster bandages are applied over a pair of knitted drawers; the pelvis and both thighs, the diseased one in the abducted position, are included. The case may be strengthened by strips of aluminium, and should be renewed every six weeks or two months.
Ambulant Treatment.—When the patient is able to use crutches, the affected limb is prevented from touching the ground by fixing a patten on the sole of the boot on the sound side. This may suffice, or, in addition, the hip-joint is kept rigid by a Thomas' ([Fig. 118]) or a Taylor's splint. The Thomas' splint must be fitted to the patient under the supervision of the surgeon, who must make himself familiar with the construction of the splint, and its alteration by means of wrenches.