Hessing Apparatus

HESSING APPARATUS (Hessing) has become widely used in the ambulatory treatment of inflammatory diseases of the hip joint (coxitis) and, in part, for congenital hip dislocations. The apparatus for treating coxitis is indicated only in cases where, after prolonged rest, pain has completely disappeared and the patient has been put on their feet with the help of crutches. In the initial period, some orthopedists apply a light fixation (zinc-gelatin) bandage under the Hessing apparatus (see Figure 1). Somewhat later, with the help of hinges, slight mobility is created in the hip joint, provided that the pain has completely disappeared. The Hessing apparatus consists of three main parts: a leg segment, a pelvic segment, and a part connecting both segments. The leg part is a sleeve (see Figure 2), reinforced with metal splints on the sides, with lacing in the front. Thanks to the hinged connection of the splints in the area of the knee and ankle joint, mobility is created. A feature of the leg part of the Hessing apparatus is the adaptation of the upper edge of the sleeve for sitting; in addition, the apparatus has a device for traction. The pelvic part of the Hessing apparatus (see Figure 3) in the second modification consists of two generally identical parts for both hip joints. The pelvic belt encompasses the pelvis in the form of a semi-corset, with the descending part on the back needing to fit very tightly to the pelvis. The trochanteric part of the pelvic ring is a splint which, by means of a screw, connects to the front end

Figure 1.

of the pelvic belt and which descends below the spina along the outer surface of the pelvis. The pelvic section of the apparatus is lined on the inside with soft fabric consisting of leather and soft flannel. In the inguinal region, the padding must be thicker. The connecting part of the apparatus between the leg sleeve and the pelvic belt is a strong steel splint, connecting at the top to the lower part with a screw or rivet, and which has a double hinge at the level of the hip joint. This hinge allows for flexion and extension movements, as well as abduction and adduction. Hessing himself did not connect the devices for abduction and adduction to the apparatus. He achieved this through appropriate adjustments within the apparatus. In many cases, Hessing arranged a so-called anterior traction. This device is intended to counteract the tendency toward flexion contracture or to correct it if it has arisen.

Figure 2.

Front view.

Rear view. Figure 3. Although the idea of manufacturing a plaster apparatus belongs to Beely, the credit for the Hessing apparatus lies in a number of technical improvements and the strict implementation of the principle: every patient must have their own apparatus, fitted specifically for them. The advantage of the Hessing apparatus consists in good fixation, in the particularly tight encompassing of the pelvis, and in great adaptability, which allows the apparatus to be used even in cases of severe deforming hip positions; furthermore, it allows for the ability to maintain the connection between the pelvis and the thigh in any position. Finally, thanks to the possibility of making adjustments in the apparatus, it is suitable for many years of use, as a result of which the apparatus, although expensive to manufacture, becomes cheaper due to long-term wear. A mandatory condition in the construction of the Hessing apparatus, as with other apparatuses, is precise modeling during the manufacture of the negative, as well as mandatory fitting and delivery of the apparatus to the patient under the supervision of an orthopedist.