In the more resistant older cases, where manipulative reduction has
failed, reduction by incision can be employed with success, but this
procedure requires the exercise of care in order to do as little injury
to the muscles as possible. A crucial incision of the capsule is made
and the capsular constriction and ilio-psoas tendon divided. With a
little traction, the head of the femur slips easily into its socket.
The capsule is stretched firmly around the neck and the incision into
the capsule is then closed by suture, and the limb fixed in a plaster
of Paris spica in the fully abducted position. The operation should of
course be done under the strictest asepsis.