280 THE JOURNAL OF BONE AND JOINT SURGERY PREMATURE EPIPHYSIAL FUSION AT THE KNEE COMPLICATING PROLONGED IMMOBILISATION FOR CONGENITAL DISLOCATION OF THE HIP

Gill (1944) first showed that shortening of a limb affected by tuberculous disease of the hip could be caused by premature fusion ofthe epiphyses ofthe knee. Jones (1899) estimated the frequency of such shortening at about 15 per cent. It is now established that premature epiphysial arrest at the knee may complicate prolonged immobilisation for many other hip conditions such as pyogenic arthritis, chronic osteomyelitis and slipped upper femoral epiphysis (Ross 1948). Kestler (1947) described a case of premature epiphysial arrest in association with congenital dislocation of the hip and we wish to record three further cases. CASE REPORTS Case 1-A girl of nearly four was found to have congenital dislocation of the right hip. She was treated on a Robert Jones abduction frame for six months, and thereafter in a bilateral plaster-of-Paris hip spica in the “ frog “ position for eleven months, after which she was allowed free. Eight months later, because of a persistent 90 degrees lateral rotation and 30 degrees flexion deformity of the affected hip, Pugh traction was applied followed by seria