SLOB

SPML can reverse SOME that have 'uncovering' and 'mild' displacement, but it isn't guaranteed. Better function – sure. Reversal of hip deformity, maybe. Before we had SLOB intervention we gave many a trial period with SPML alone. As shown above. Things that we are sure to make luck less likely include seizure activity without good control, dystonia especially with windswept posture, megacolon that isn't remedied, and older patients with less biologic ability to remodel bone. Megacolon? Distended bowel is common in dystonia. Common is not OK. Custer's soldiers commonly had arrows in their chests. Distended bowel sets up a neurological howl that manifests as amplified reflex lower limb dystonic posturing. It causes hip dislocation . Also, unwitting clinicians are treating REFLUX that originates with colon distention that loses propulsion directionality. High bacterial load also makes these kids look and feel sick. Hence we have “TOXIC” megacolon. Parallel loops of small bowel seen on hip screening x-rays should alert you to the need for a pediatric gastroenterologist, and not Nissen fundoplications for undiagnosed colonic stasis causing reverse peristalsis. When there is visible paralytic hip dysplasia in these children (especially those with dystonic features) then SLOB is far easier and safer than VRO or VRO plus pelvic whatever. VRO is so asymmetrical (lop sided) that it is seldom done unilaterally. Bilateral VRO is a massive metabolic hit. That metabolic cost overload manifests as wound problems, nonunion, metal breakage, and lots of stuff that would not otherwise

be suspected. If you understand burns then you understand this. The word is not out in many places. So, we see late comers.

We glossed over detail of what SLOB is. We will fix that now. Angular pressure of the femur presses the acetabular back wall backward and flatter. The hip ball displaces within this advancing pocket that it plows.