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Patient 132/1951
This patient had developed a limp and was taken to the school doctor. Following x-rays he was admitted to Earl's House Sanatorium, Durham but was removed by his mother after 8 weeks having received no treatment and no education. He continued to be seen as an out-patient at Durham County Hospital and was eventually referred to Fleming Memorial Hospital, Newcastle. The referring physician from Durham reported his condition as follows:
"This lad is in the 3rd stage of tuberculous disease of the right hip joint. There is considerable erosion of the acetabulum and femoral head and the leg is fixed in flexion and adduction."
He was treated as much as possible whilst in Fleming Memorial Hospital and was immobilised in a plaster spica before being transferred to Stannington, being considered quiescent with the beginnings of ankylosing. One of the reasons for his transfer to Stannington was to continue his education; a letter between the Fleming and Stannington states that at 9 years of age this boy could neither read nor write. Physical examination on admission in November 1950 revealed the patient to be underweight; to have scarring from previous pressure sores in the groin area and one fresh one; to have slight give in the right hip with marked external rotation but to be fixed in a satisfactory position. There was no abscess or sinus formation and it was agreed that he was clinically quiescent. It was recommended he be put forward for an ishio-femoral arthrodesis. He was removed from plaster in March 1951 due to muscle wastage and cavus deformity to both feet and put into a Thomas Splint to encourage walking. His x-rays had remained unchanged since his admission and the arthrodesis was arranged for the end of the school year to avoid further interruption to his education. He was transferred to the Royal Victoria Infirmary on the 3rd September 1951 for the procedure, which is described in a letter from the surgeon at the RVI:
"... a cortical graft was taken from the anterior aspect of the right tibia. This wound was closed with catgut and silk-worm gut to the skin. The right hip was approached from an incision over the posterior aspect of the greater trochanter... The shaft of the femur was divided just below the greater trochanter and a gap made in the ischium. The bone graft was inserted into two gaps between the femur and the ischium. The wound was closed with interrupted catgut and silk-worm gut sutures. The leg was set up in 30 deg abduction and a plaster spica was applied."
Patient 132/1951 was readmitted to Stannington on 15th September 1951. In January 1952 he underwent physiotherapy including muscle exercises and knee movement for quick progression to ambulation. As a result of the surgery there was flexion in the right hip and some apparent lengthening of the right leg which was compensated with a raise in the left shoe. He made good progress and in August 1952 it was noted that no clinical signs of activity could be seen and x-rays showed a sound ishio-femoral arthrodesis with the commencement of fusion in the hip joint. He was discharged but returned as an out-patient until 1957 where his final out-patient report states: "Excellent. Now training to be a shoe repairer. Walks well. Sits well. Can ride bicycle."
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