Fig. 118.—Thomas' Hip Splint applied for disease of Right Hip. Note patten under sound foot. The foot on the affected side is too near the ground.
In children who are unable to use crutches, a double Thomas' splint is employed; the child thereby is converted into a rigid object, capable of being carried from one room to another and into the open air. Personally we have obtained satisfaction from the double Thomas' splint employed for spinal disease, which extends from the occiput to the soles of the feet.
The fixation of the hip-joint and the taking of the weight off the limb by one or other of the above methods, should, as a general rule, be continued for at least a year.
Should an abscess develop, it is treated on the usual lines.
Operative Interference.—Widely diverse opinions are held on the question as to whether or not recourse should be had to operative interference.
Some surgeons are opposed to operative interference, on the grounds that however advanced the disease may be it will yield to conservative measures if judiciously and perseveringly carried out. Other surgeons advocate operative treatment in all cases which do not speedily show improvement under conservative treatment. An intermediate attitude may be adopted which recommends operation in cases in which the disease progresses in spite of conservative treatment, and in which periodic examination with the X-rays shows that there are progressive lesions in the upper end of the femur or in the acetabulum.
It is claimed by those who advocate operation under these conditions that pain and suffering are at once got rid of, sleep is restored, appetite returns, and there is a marked improvement in the general health, and that this result is obtained in months instead of years, and that the cure is more likely to be permanent. It is certainly unwise to delay operation until sinuses have formed, as such a course is largely responsible for the bad results which formerly followed excision of the joint.
Amputation for tuberculous disease of the hip has become one of the rarest of operations, but is still required in cases which have continued to progress after excision, and when there is disease of the pelvis or of the shaft of the femur, with sinuses, albuminuria, and hectic fever.