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Paul H. Martin
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Jacksonville, Florida
1948 by The American Orthopaedic Association, Inc.
J Bone Joint Surg Am, 1948 Jan 01;30(1):9-19
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1. Most poor results are caused by improper treatment, and are due chiefly to avascular necrosis in the epiphysis.

2. Necrosis in the epiphysis is caused by further damage to its blood supply through the ligamentum teres and the periosteum on the posterior and inferior aspects of the neck.

3. Manipulation should be condemned except in acute traumatic cases, and it should be gentle. If reduction is not easy, closed methods should be abandoned.

4. Patients in the so-called preslipping stage and those with minimal slipping (less than one centimeter) are best treated by nailing in situ without reduction.

5. When displacement is more than one centimeter, and is gradual or has existed longer than two weeks, open reduction should be done without preliminary manipulation. This must be accomplished with due respect for the blood supply of the epiphysis.

6. In old united cases, if there is a good hip joint, intertrochanteric osteotomy may be beneficial. Later in life, arthroplasty offers much improvement for the old arthritic hips and especially for the cases with ankylosis.

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