Carny Kid: Puberty on the Midway
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What may seem even more outrageous to kids today is that were no cell phones. So your parents only had a vague idea of where you were and no real way of contacting you. If your mom wanted to find you to tell you to come home for dinner, she'd flag down the nearest kid on the street who would then activate the kid network until, a while later, you were approached with "Hey, Skip, your mom is looking for you. I walked to school and home from school, about a mile, with no adults beginning in kindergarten.
Often there were other kids to walk with, but if there weren't I still just walked. I feel like I'm being daring and possibly irresponsible as a parent when I don't go meet my kids' bus 1st and 4th grade three houses down but wait for them in the front yard. I was allowed to walk or bike by myself to the library when I was 7, and to our town center when I was 9 and just, like, go shopping with my allowance. I also started babysitting for pay when I was 9. No stores were open on Sunday morning at all. There was a convenience store that opened at about 11 a.
This wasn't a particularly Christian community Jewish, in fact , nor did it have blue laws, stores just weren't open on Sunday. Stores in general had much shorter hours; I can still remember when we got a hour pharmacy. It was very controversial. Before that if you got sick at 9 p. My mom used a diaper service and cloth diapers with me; she was pretty relieved to switch to disposable when my brother came along two years later and they were commercially available. By today's standards of carseats, they were not too good; they mostly just held the child strapped into the seat, they didn't provide particular extra padding or crash safety.
The law in my state now has kids in various forms of car seats until they turn 8. Yeah, seriously I used to be able to go into stores as a kid and buy cigarettes for my relatives. I completely forgot about that. I also was left in the car while my mom went into stores. I started watching my 3 year old brother at home for short periods of time when I was 10, although Mom now denies either of those things happened. I think she feels bad admitting it now because of the super-charged atmosphere around modern parenting. Also, pre-internet, kids from your school but not your neighborhood who moved over summer break completely disappeared from your life with no followup or goodbye.
Boom, gone. In junior high, I had to get special permission to take wood shop instead of home ec late s because I was a "girl. This started around age 6. I almost had a non-alcoholic drink like a Shirley Temple that made me feel more adult same with candy cigarettes. Wisconsin has a huge drinking culture though. When my grandparents started opening their store on Sundays in the s, the priest called them communists small town Illinois.
I'd forgotten all about birthday spanking, but yeah, not from the teacher. Also getting pinched on St. Patrick's day if you didn't wear green. Had to wear dresses to school until 6th grade. Being sent outside to be a free range kid until time to eat. Wandering all over town by foot or by bike with no fear. Baking by the pool all day, every day, in the summer. Friends of my parent's being able to discipline me if they saw me getting out of line. Getting free sample cigarettes for my parents at street fairs, etc.
Smoking area for folk over 16 at my high school. No car seats or seat belts in the cars along with piling up in the back of my Dad's truck to get him to drive us around town. Good times. Lords Prayer before lunch in the 90s Smoking area for students in the early 00's posted by stray at AM on September 29, I spent a lot of time in bars as a kid growing up in Wisconsin, mostly while my dad bowled. I'm pretty sure legally you still can bring your kids into bars, but I don't think it happens as much. You'd go to the house of someone you knew from school, knock politely, and when the mom always answered the door, say, "Hello Mrs.
May I use your phone to call my mother and let her know my bike chain came off so I'll be late getting home? It's funny to me that this wasn't anxiety-inducing because I hated interacting with strangers, but it was just the super-normal way you got in touch with your mom. In you could transport 9 kids in a VW Beetle as long as they were small: one in the front, three on the back seat, three on the floor behind the front seat, two in the back window well.
We carpooled to school like this more than once. At least until my parents got divorced, one income was sufficient to support a family with three kids, and my mom could stay home with us. Both my dad and my grandpa belonged to unions even though they were managers. My parents expected my standard of living to exceed theirs. Ok I'll stop being Debbie Downer now. Oh yeah, we'd do calls like that when we wanted a sudden sleepover or staying for dinner definitely had to get the call in before whichever parents hopped in the car to get us! Oh yes--I more than once sat on someone's lap in the front seat on a car trip involving getting on the highway to go somewhere, and no one thought of this as particularly dangerous or illegal.
Ditto for riding on the passenger footwell. My dad recalls in one of his science classes, they would pour a bit of mercury into everyone's hands so they could see how weird it was. Also my parents' generation - sometimes trucks or planes? My grandpa was tasked with painting the barn as a kid and remembers mixing packets of lead powder into the buckets of paint. When my mom was in high school, a male teacher would often drive her home from theater rehearsal since she lived on his regular route home.
He never tried anything, but compare it to my high school experience, where when I was studying alone in a classroom with a male teacher and I asked if I could close the door, he explained that wasn't allowed when it was just one student with one teacher.
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My oldest aunt would regularly babysit her younger siblings all five of them! Probably explains why she got married at My grandma told her kids "boys get college, girls get weddings," indicating what they'd be willing to pay for. And my two uncles did go to college, while the four daughters had their weddings paid for by my grandparents. It was understood that there would be no wedding money if you moved in with a man before you were married.
As a '90s kid, I don't have as many examples, but I was able to wander into any random chat room in the very early days of dial-up Internet and AOL on our home computer, at age 8. If I had to sell fundraising wrapping paper or Girl Scout cookies, I'd just set off by myself around the neighborhood going door to door, sometimes being invited into homes of mostly strangers. After I got a driver's license, my mom would send me to the grocery store with a list and a signed blank check, and I would just fill out the final total of groceries when it was time to check out.
That was only 15 years ago but I don't think it would work now. Wow, I had utterly forgotten about the birthday spankings thing. I was in elementary school in the eighties, and my sixth grade teacher male once gave me female a Hershey's Kiss as some kind of reward, but then winked lasciviously and said, "Don't tell your mom I've been kissin' you! Yes to riding in the way back of the station wagon, and getting to ride in the front seat a fair amount, too.
Carpools seem like way less of a thing nowadays also, because of kids needing to ride in boosters seats until quite late and no convenient way to ensure you have enough for everybody. I remember riding in the bed pickup trucks occasionally, either by necessity or as a special treat. It was quiet and peaceful and my books were so much more interesting than the grocery store. Relatedly, my mom regularly deposited me in the book or toy aisles to explore while she did the Target shop and would come and collect me when she was done. There were no mall curfews back then for teenagers so we could roam the place until it closed on weekends.
I grew up on a lake and we swam unsupervised all the time. I mean, we'd let my parents know first but they certainly were not sitting out there keeping an eye on us. Sometimes we went night swimming after they went to bed. When we visited a friend's cabin, us kids all under age 10, I'm sure took the paddleboat out by ourselves while our parents had happy hour. We had life jackets on and stuck close to shore, but I cannot imagine parents being remotely okay with their kids using watercraft on their own today.
I spent a lot of time in bars as a kid growing up in Wisconsin Wow, forgot about this. Sibling and I would be brought to our parent's regular bar, given KitKats and Shirley Temples, and just kind of be That pretty much ended by the time we were in middle school, but still.
All metal roller skates that clamped onto your sneakers. You needed a key to adjust them. They sometimes fell off mid-skate. No protective gear. When I was in undergrad mid-late s a lot of checking accounts still didn't come with a debit card. So although ATMs existed there were still a lot of students who got their weekly cash by cashing a check at the check-cashing service in the student union. My fifth-grade teacher, who specialized in science and math and really should have known better, one day poured out a puddle of mercury on one of the desks and let us poke at it for awhile.
He also had us do glass bending with acetylene torches. Riding around in the back of my friend's dad's pickup truck. Goddamn lines. Lines everywhere, for everything. So much sheer waiting with no distraction. Still does, but now with devices and wifi. Oh the waits there! Everybody did everything as a group, all with lines. Everything took much longer to do and you had no amusement while you were waiting but chat unless you had a newspaper or were a weirdo who carried a paperback with him everywhere.
One of my friends failed fourth grade and was held back. I don't think that's a thing anymore. In class when we had to use the restroom, we raised our hand and held up 1 finger or 2, to let the teacher know what we had to do in the bathroom. We had a party phone line - if you were going to make a call you'd pick up the phone and listed to see if any of your neighbors were talking.
If you were talking, you'd hear neighbors picking up. And it wasn't unusual for an adult neighbor to interrupt and ask you to get off the phone. It also made a handy excuse for my mother who insisted it wasn't her eavesdropping on another extension; it must have been a neighbor. Many of our older female friends and relatives didn't drive. We were expected to obey pretty much any adult and not sass them.
Grandparents got at least as much respect as parents. We called aunts and uncles "Aunt name " and "Uncle name ," never just their name. I don't observe this stuff among my nieces and nephews these days. Hand-me-downs meant a lot of stuff was more gender-neutral. There wasn't special food for kids; we ate the same dishes the adults ate, except we were generally drinking milk instead of water or coffee or whatever they had. My parents and I didn't really communicate personal things.
They never would have had 'the talk' with any of us kids. It didn't really matter because I was just a kid. That got me into the habit of not really communicating, though, so when I went off to college I didn't talk to them about my grades or anything, and they didn't tell me I was most likely still on their insurance, so I suffered through some things I really should have seen a doctor for but thought I couldn't afford it.
Here's one more person raised in Southern California who remembers "the spanking machine," where kids lined up and stood with their legs apart and the birthday celebrant had to crawl through the line and get spanked. My sister and I never wore seat belts in the back seat of any car and no adult ever told us we had to. We and other friends I know were often just dropped off at a movie theater and then picked up two hours later; my sister and I saw Poltergeist without an adult.
In , my kindergarten room had as a standard activity a big wooden stump with a hammer and nails sitting by to be pounded into it. Born and experienced the sort of pedestrian! I also had some other more advanced parental flexibilities, so maybe out of scope in terms of "normal" but no one questioned it at the time. My dad post-divorce worked on a traveling carnival for a number of years, and my brother and I would spend the summer with him yes, I am apparently to some degree a carny , moving from crappy small deep south town to crappy small deep-south town, spending a few days or a week each place.
We were basically allowed to do anything, the rest of the adults who ran the carnival knew us and we could eat and drink anything non-packaged! No, my friends back home did not believe me either. More alarming was that we, the carny kids, were allowed absolute free reign. So, the carnival would set up in some fairground outside some sleepy town Hannibal, Missouri is one I remember specifically and we would be free to do whatever the eff until dinnertime, and then again until the carnival closed at maybe or Sometimes we'd swing by and say hello to dad, but sometimes we'd be gone basically all day.
I was nine years old. I went with some other kids into some abandoned and falling down storefront in a very apocalyptic skid row feeling neighborhood outside the fairgrounds and one kid found a gallon jug of something or other and decided it would be a great idea to douse me in it, which he did, and my clothes immediately began smoking and falling apart, skin burning feel wise, not actual! Reason I bring it up, though, is that the reaction of all the adults was basically like, "Haha, oh, you kids!
But yeah, a dozen under-tweens tromping around a disused industrial area next to a giant rushing river, in the dark, throwing explosives at paddleboats, was like a wholesome thing that all the kids did, and no one - not the riverboat people, not our parents, not the town's law enforcement community - thought there was anything off about it. God, reading this back I feel like this was in and not Silver dollars?? Surprising little had changed between my childhood and my childrens', but my grandchildren live in a different world. No car seats for kids when I was a kid, nor when my kids were small.
We drove cross country in an old van with me holding my two year old on my lap! No safety gear for bikes until one of my kids got into BMX bike racing, and when my youngest got inline skates and did tricks on rails etc, he did have protective gear. As a kid I had those skates that clamped onto shoes with a key. Like me and my brother, my kids went out on their bikes with their friends after school every day and just had to be in for dinner when the 5 o'clock whistle blew.
One big and serious thing that has changed is allergies, nobody had serious allergies that I knew about when I was kid, and when my kids were young they took peanut butter and jelly sandwiches for lunch every day. My little grandson who is 21 moths old has already been diagnosed with a serious peanut allergy. This is so common now but was unknown thirty years ago.
Another medical one, just about every kid had their tonsils out when I was small. None of my kids did, and now they only do it if the child has repeated infections. It was a real rite of passage for "Mr. Smith" not real name to pull our super-wiggly teeth when we were kids. Horn at AM on September 29, [ 3 favorites ].
This exact thing happened to me recently! My mom, my wife and I were talking about how somethings were done differently Back Then, and I said to my mom "yeah, you used to leave me in the car all the time when you ran into the store or something. My mom was horrified. Truth be told, I don't think she even remembers. It was such a normal and unremarkable thing when I was a kid this is the early s that there's really no reason why it would stick out in her mind. Some other stuff: Smoking sections in restaurants. Casual homophobia. Before the Internet, other kids would move away and Around or New York State passed a law that kids under a certain age I think 13 had to wear bike helmets.
I was about My mom got me one and I hated it. She talked me into trying it and I wore it maybe two or three times. Most of the other kids didn't wear one either. This law was evidently not very well-enforced. The general consensus was that this was not a thing that you would want because it would allow your parents to keep tabs on you. I had one friend who had one. As a aside, candy cigarettes are still a thing. I saw them for sale at the Virginia State Fair just a few years ago. My parents left me home alone at age 7 with my 4 year and newborn baby brother.
As soon as the baby was down for the night they'd head out to the bar and leave me home alone. This was the mid 70s so it wasn't like I could call them if there was an emergency. All 3 of us survived to adulthood, although my youngest brother voted for Trump so it's possible there was permanent damage. It's illegal to leave a kid under age 12 home alone in my county today.
As young as age 5 or 6 I simply went "out" on the weekends of after school. As long as I came home at the appointed time for lunch or dinner my mother really had no idea where I was or what I was doing. That never seemed to concern her. A couple other things I thought of: - One semester in about 8th grade, I took a weightlifting class for PE because I didn't want to do a team sport. Apparently a lot of us didn't, because it was a full class!
We had girls' PE and boys' PE that semester it had just started becoming co-ed and so the weightlifting class was all girls. No teacher helped us use the machines correctly or anything - we were given the barest minimum advice on how to work the machines and then the teacher left to do crossword puzzles or something. However, she told us - several times!
Doghouses were still a thing because even in the enlightened Bay Area, many dogs were outdoor-only. And most of my friends' cats were not allowed inside at all, not spayed or neutered, had litters of kittens the lucky ones were given away in front of supermarkets, the unlucky ones were taken to the pound or worse , and most eventually were hit by cars or "just ran away. Banks at AM on September 29, [ 8 favorites ]. Grew up in the 80s. Certainly not the whole family.
Maybe fast food occasionally. But a sit-down restaurant? Nope, too expensive. I feel like going out to eat is much more common now. And yes to buying cigarettes for my mom when I was probably 6 or 7 years old with a note from her. Yes to birthday spankings. Haven't thought about that in a while - apparently it's not a thing anymore. Only from family though, not at school. So much free time as a kid. My mom's favorite saying at the time was 'Go out and play. We would knock on people's doors early 90's and ask to use their swimming pools.
The answer was almost always yes. Then one day the owners of a pool we swam in regularly sold their house. We banged on the door and asked the new homeowners if we could swim. They looked uncertain, conferred, and came back and said no. I don't remember how they explained it but the gist was that they didn't want to be liable should we get hurt. Another time the local state park closed down a large hill people liked to go sledding on. It was closed just like that and was never reopened, because someone hurt themselves and sued the park.
We went there with our sleds and they'd posted the sign and that was it. No more sledding. Also, while we had more freedom to run around the neighborhood than we probably would today, all parents were aware of the possibilty of kidnapping and we were all taught not to talk to strangers or to stray too far from home.
Oh, here's another one: We would play in the street. All the time. Often ballgames - basketball, football, whiffleball, kickball. But sometimes also tag or weird stuff we'd make up or just running around. Is this something that kids still do? I feel like I never see it. Candy bars were not a thing. There was chocolate, it came in bars that were divided into squares, and they were meant to be shared or eaten one square at a time.
The idea that you got a chocolate thing the size of a candy bar, and it was okay to eat it all at once, all by yourself It did, in fact, do exactly that when we went to a circus circuses! For us, it was just another of those magical things that happened at a circus. Later we got different types of candy bars: Milky Way, Drie Musketiers three musketeers , and Snickers. By then, we were used to the concept. It looks like I answered the question in reverse. I hope it still works for you. It doesn't; it helps protect you from flying glass and debris.
It's not like you stay down there for hours-- you're supposed to get up and walk out of the fallout zone as soon as the bombs have stopped falling, and that's easier to do when you aren't bleeding from shrapnel, blinded by flying glass, etc. When a teenager, I was sent to the mall to buy school clothes and to pay, I used my stepmother's credit card.
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No one blinked an eye. We still throw our kids outside and say "go play" and kids still roam around our neighbourhood and wander down to the corner store or to the park. They often all end up in our basement playing video games. We try to discourage them from going down into the ravine during spring runoff, as the creek gets pretty high. And they have to get home from the park before dark. The unabashed sugariness of breakfast cereals seems weird looking back from today's point of view. I was born in , so I remember a lot of this stuff but I was a pretty timid, only child so I never wandered far from home.
I do remember the Fuller Brush man coming by the house fairly frequently, maybe weekly or monthly? My mom would invite him in and chat and maybe place an order and always served him coffee. He was a nice man but I can't imagine that today. Can I use one from my late father? It's perfect for this ask. He used to take his rifle and hunt for pheasant on his way to school.
If he got any, the cafeteria ladies let him put them in the fridge. Then he would unload his rifle and leave it in the cloakroom until school was over, when he'd reload it and hunt more on his way home. This would have been around just outside Detroit, at that time the area was sparsely populated. I live near that school now and tell neighbor kids who attend that school this story, they LOVE it.
There was a smoking lounge in my high school, and people smoked in lecture halls when I went to college. Oh, cats were declawed as a matter of course, and it was not popularly understood how painful and cruel this was. I feel like some time in the nineties it stopped being a thing and now I don't know anyone with a declawed cat or a vet who would do the operation. Also, animals didn't get painkillers after surgery. When I got Dr. Cat and had her spayed, we got a bunch of little syringes of pain-killer meds to give her and I was really surprised.
I am ashamed to say I'd never even considered how much animals must have hurt when recovering from surgery before. And just as you might expect, being able to doze in relative freedom from pain speeded her recovery - cat painkillers FTW!!! I was born in the late 70s and I remember hiking deep into the forest behind my house and building tree houses with other kids that were rickety at best.
My friends and I would walk a mile or so to the local pool and stay there all day, starting at age Same with the huge theme park in the next city -- someone's parents would drop a gang of us off in the morning and someone else's would pick us up that evening. Mall culture. I walked to school and piano lessons every day starting in 3rd grade.
We could leave for lunch in high school. No metal detectors, no security guards. When they did random locker checks a couple times a year with a drug dog it was a huge deal to have police at the school. In elementary school the principal would spank kids who got in trouble. The car at the time had a foot-switch to activate the high-beam headlights, and activating it, even with the car off, would turn those lights on.
There was also no dashboard indicator that the lights were on. I guess one time when I was very little I somehow triggered the light, my dad never noticed, and it drained the battery. Of course all cars at the time had ash trays and electric cigarette lighters.
We didn't burn anything, we just liked watching the coil go from red-hot to grey as it cooled. I think we were warned to be careful not to burn each other or ourselves, but never told not to play with it. My husband had a paper route starting when he was 7!!! Born From then on regularly travelled longer distances solo by train to visit family in the school holidays.
I also remember birthday spankings from family, not teachers , and they ended with "and one to grow on.
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Biking everywhere. Riding in the backs of trucks. Playing in the forest unsupervised. We should add: metal playground equipment that got super hot in the Texas summer, especially the slides. And none of the soft mulch playgrounds have now. We slid down metal infernos and bounced off of hard clay ground. Mall culture deserves more elaboration. Malls, now dying, used to be popular hang-out spots. Stores, food, and movies, all in one spot.
Starting around age 12 parents would drop kids off at the mall to hang out with friends and come back hours later to pick them up. There was always a video game arcade at the mall, too, since home video game systems couldn't compete with the superior graphics off the stand-alone games.
Someone mentioned blue laws. I don't remember what all they covered, but at least in my hometown the list of things you could by on Sundays was pretty small. Just the essentials. I remember going into the grocery store on Sunday and seeing the sign telling us what things were legal to buy.
On a related note, back then there were never sports games or practices on Sunday because it interfered with church, and Wednesday night was usually avoided too because of midweek church services--at least in small-town Texas. I remember entertaining myself for hours with Mad Libs, choose-your-own adventure books, and a deck of cards. I'd sit and play actual solitaire with physical cards. One day when it was snowing my dad drove my brother and I to school and I sat on his lap and worked the steering wheel.
No seat belt. We went into a snowbank. I must've been about 7? I grew up in West Hollywood in the 70s, during a huge construction boom. In 5th and 6th grade we used to play in the construction sites after school which weren't boarded up back then playing tag, and running around on the scaffolding. There are probably 30 different things right in this example. We didnt have any have a smoking lounge in HS, but no one ever got in trouble for smoking at the gates, maybe even at certain places on campus.
Oh and lots of kids made pipes for smoking pot in wood shop.
Carny Kid: Puberty on the Midway
Here's one from my father's time probably the late 50s rather than my own. When he was little, his parents were in the process of building a lake house a couple hours drive from their home. My grandmother and the kids four of them would stay up on the property all summer, while my grandfather commuted up for the weekend in their only car. A few years ago I found myself up for a weekend at that same property alone with no phone service and I briefly thought, "Is this safe? More recently, my neighborhood friends and I used to wander the runways of our local municipal airport our houses backed up onto it and go to the airport snack bar for hot dogs.
At some point we were asked to stop, which makes sense! Guessing based on when we moved from that neighborhood, we would have ranged in age from maybe 5 to 9? And I'm pretty sure the teacher's lounge at my middle school was a smoking area! Speaking of riding in the back of a pick up truck, Subaru actually made the BRAT , which had built in plastic seats.
It sounds like fun, but I did this once on the freeways of SoCal and it was terrifying! F- would not ride again. Yes, we had birthday spankings in school, both parochial and public. The class would stand in two lines facing each other, and you had to walk between the lines as each kid lacked your bottom either with a ruler or an open hand. We had regular fallout drills at school. A bell different from the fire alarm would ring, and we'd all troop down to the basement, where we'd line up in the hallway. The first line of kids would face the wall, fold their arms over their faces, and lean forward.
The next row of kids would do the same, leaning against the shoulders of the first row of kids. I remember being in the hospital once and my mother not coming to see me because she would have to go all the way down the hall to a smoking lounge to have a cigarette instead of smoking right in my room. Almost all public buildings had built-in ashtrays: banks, post offices, courthouses, you name it. I don't think either of us used a seatbelt until our ages were in the double digits.
When we were too little to sit up in the car, Mom either held us or put us in a big wicker basket. When we were older, our family car was a brobdingnagian Plymouth Fury with a big bench seat in the back. Of course, all this automotive leisure was punctuated with minor burns to upholstery and young bodies when the still-lit cigarettes thrown by the adults out the front windows promptly flew right in the back ones I was fed all kinds of garbage when I was a kid. I think I subsisted on hot dogs and corn chips and fast food.
The school cafeteria served greasy pizza. There seems to be a much greater focus on nutrition these days. Certainly there was no organic anything back then. We weren't just sitting in the bed of the pickup, we'd be perched right up on the edges. After our softball games every member of the team would climb into the back of one of the parents' trucks, find a place to sit -- on the wheelwell worked, those went first -- and chant and cheer as we rode to the Dairy Queen or other similar place to get ice cream after the game.
The opposing team'd do the same. My very sweet spinster second grade teacher would read to us after lunch and the girls would take turns giving her backrubs while she read. The better the backrub, the longer she would read. This was early '80s in the Hudson Valley. The use of CT scanning allows direct measurement of the acetabular version [ 39 ].
On the AP view of the pelvis, there are three signs which suggest abnormality of the acetabulum related to FAI: the posterior wall sign, the crossover sign and the ischial spine sign. Normally, the lines representing the anterior and posterior wall of the acetabulum meet at the lateral edge of the acetabulum on the AP view; however, if the acetabulum is retroverted, they are seen to cross over each other the crossover sign. The posterior wall sign is when the posterior wall line is projected medial to the centre of the femoral head.
The ischial spine, which is not normally visible on the AP view, becomes visible in acetabular retroversion the ischial spine sign. It is extremely important to get an accurate position of the AP view, as the position of the centre of the beam, pelvic tilt and rotation can affect the three signs of retroversion [ 40 ]. The AP pelvic view may reveal a flattened femoral head or a pistol grip deformity, both of which are associated with cam lesion.
An alpha angle is a parameter used to quantify the degree of femoral head deformity and can be measured on the lateral view of the proximal femur. This is the angle between the longitudinal axis of the femoral neck and a line connecting the centre of the femoral head with the point where the femoral head loses its sphericity [ 41 ]. A greater angle suggests abnormal femoral head—neck contour. A trial of non-operative management, including activity modification and non-steroidal anti-inflammatory drugs NSAIDs , may have some role in controlling symptoms.
Emara et al. They found that non-operative treatment was effective in improving function and symptoms, although no improvement in the range of motion ROM was noted. Whether these symptoms returned is not known, as no longer follow-up was reported. However, adolescent patients with idiopathic FAI typically have high activity levels and athletic ambitions that make non-operative management only successful temporarily [ 16 ]. Patients treated in this manner should be followed up closely, as continued impingement can lead to the progression of damage to the labral-chondral complex and subsequent development of OA [ 44 ].
The surgical treatment of symptomatic FAI is focussed on correcting the impingement morphology, thereby, improving hip motion and alleviating symptoms and delaying the progression towards early OA. Surgical intervention can be accomplished in various ways: Open surgical techniques involving safe surgical dislocation of the femoral head, with additional intervention, including femoral or pelvic osteotomies PAO , as deemed necessary on a case-to-case basis. Mini-open methods that do not involve a trochanteric flip osteotomy and a complete surgical dislocation.
These techniques may involve arthroscopic assistance as well. However, if the deformity underlying the FAI is severe, such as those associated with LCPD or SCFE, an open approach may be more appropriate, as it allows procedures like proximal femoral osteotomy and periacetabular osteotomy to be performed in conjugation with the osteochondroplasty, as the latter alone may be insufficient to permit impingement-free ROM.
Ganz et al. They reported no osteonecrosis in a series of patients undergoing surgical hip dislocation using this technique. The technique has been successfully applied to paediatric and adolescent patients [ 6 , 11 , 46 , 47 ]. There are no studies on the outcome of SDO in the treatment of FAI in a purely adolescent population; however, there are three mixed studies available [ 6 , 11 , 14 ].
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Peters and Erickson [ 6 ] treated 30 hips in 29 patients; mean age 31 years using the surgical dislocation technique described and debridement with or without relative femoral neck lengthening and a minimum follow-up of 2 years. The mean Harris hip score HHS improved from 70 pre-operatively to 87 at final follow-up. All three patients had grade IV acetabular cartilage damage and the authors emphasised the need for better imaging methods to assess the articular damage. Similar improvement in HHS was noted in another study by Peters et al.
Naal et al. Hip arthroscopy offers a less invasive technique for the diagnostic and therapeutic management of FAI in good hands [ 48 — 51 ]. The potential advantages of arthroscopy over open surgery include lower morbidity, less recovery time, earlier return to full activity and the avoidance of a complete hip dislocation, with less intra-operative blood loss [ 52 , 53 ]. Hip arthroscopy has been carried out in combination with an open osteochondroplasty via a mini-anterior approach [ 5 , 8 ]. Arthroscopy is first carried out to inspect the joint as well as to treat labral and chondral pathology.
An 8—cm incision made along the Smith—Peterson interval which is more cosmetically appealing if made as a bikini-line incision is utilised to expose the anterolateral femoral head—neck junction and the anterosuperior acetabular rim [ 5 ]. Clohisy et al. Resection of the cam lesion under direct vision minimised the risk of inadequate correction. Although this technique will not allow circumferential lesion of the femoral head or acetabulum to be treated, it may be appropriate for FAI, which is localised mainly anteriorly.
We identified six case series [ 3 , 4 , 7 , 9 , 12 , 13 ], two of which monitored the outcome in purely adolescent [ 3 , 12 ] and the rest in mixed adolescent and adult patients. Larson and Giveans [ 7 ] performed impingement testing pre- and post-operatively. The reported post-operative complications included transient sciatic neurapraxia, heterotopic ossification and adhesion.
Larson and Giveans [ 7 ] reported three patients who underwent total hip replacement at their most recent follow-up, but all were noted to have grade IV chondral damage at the time of arthroscopy. Laude et al. The result was promising, with an increase in the average NAHS by However, there was a case of femoral neck fracture 3 weeks post-operatively. In another study, 35 patients were treated for FAI using the combined approach [ 5 ].
The average MHHS improved from Minor complications, such as superficial wound infection, deep vein thrombosis and asymptomatic heterotopic ossification, were noted. Table 1 shows a summary of the studies mentioned above. Table 1 Summary table of the characteristics, outcomes and complications of 12 studies of SDO [ 6 , 11 , 14 ] and arthroscopic with [ 5 , 8 ] or without [ 3 , 4 , 7 , 9 , 10 , 12 , 13 ] arthrotomy to treat FAI in adolescents.
In a case of chronic SCFE with symptomatic FAI, proximal femoral osteotomy PFO can be performed in the sub-trochanteric, inter-trochanteric, basi-cervical or sub-capital region in order to help restore the morphology of the proximal femur while addressing the component of intra-articular FAI. Fixation is commonly internal, although some studies have attempted external fixation with good results [ 54 , 55 ]. The more proximal the osteotomy i. Inter-trochanteric osteotomy creates flexion, internal rotation and valgus at the osteotomy site and is used to reduce the femoral head—neck offset responsible for impingement [ 61 ].
A bone wedge from the proximal fragment can be removed to create flexion at the osteotomy site or an end-to-side apposition of the osteotomy can be performed, where the anterior cortex of the proximal fragment is impacted into the medullary canal of the femoral shaft [ 61 , 62 ]. The distal fragment is then flexed, internally rotated and translated anteriorly on the proximal fragment before fixation with a blade plate.
Whiteside and Schoenecker [ 63 ] have demonstrated that combining valgus derotational osteotomy with cervical osteochondroplasty leads to more desirable outcomes in terms of ROM and providing a satisfactory weight-bearing surface. Ziebarth et al. Leunig et al. This study reported a good outcome in all three patients in terms of symptoms and ROM, with no complications at follow-up, which ranged from 6 to 23 months.
The authors concluded that this method is effective in limiting impingement after mild SCFE and recommended that in-situ pinning and arthroscopic osteochondroplasty could be performed concomitantly or in a staged fashion. It is vital to establish whether FAI is intra- or extra-articular, and femoral or acetabular, pre-operatively in order to plan surgical treatment effectively. Various surgical procedures to correct the deformity on the femoral side have been described: inter-trochanteric osteotomy [ 68 ], relative neck lengthening with trochanteric distalisation [ 69 ] and femoral head reduction osteotomy [ 70 ].
Anderson et al. Intra-operative findings included four femoral osteochondritis dissecans OCD , which were treated with autografts created from the femoral osteochondroplasty resection. The average HHS improved from 63 pre-operatively to 95 post-operatively in the presence of an OCD lesion, and from 71 to The authors pointed out the high rate of femoral head OCD lesion in LCPD and concluded that SDO and trochanteric advancement reduces the impingement, improves hip joint biomechanics and allows the treatment of intra-articular pathology.
PAO has been used to treat acetabular dysplasia with instability secondary to an aspherical femoral head [ 72 ]. Due to the complexity of the deformity that could occur in LCPD, it can be challenging to differentiate the patients with isolated FAI from patients with hip instability caused by secondary acetabular dysplasia or a combination of both [ 34 ]. For this reason, a combined approach may be needed [ 72 , 74 ]. The mean HHS increased from An algorithm for the surgical management of acetabular retroversion has been recommended by Peters et al.
This algorithm takes into account the degree of acetabular coverage lateral centre edge angle and the posterior wall sign and the condition of the acetabular cartilage. PAO is recommended only if the acetabular cartilage is intact. If damaged, surgical dislocation with rim debridement with or without femoral osteochondroplasty is recommended, as acetabular reorientation in this scenario would position the damaged cartilage in the main weight-bearing area [ 54 ]. Using this algorithm, the HHS improved from 52 to 90 in the hips treated with surgical dislocation and osteochondroplasty and from 72 to 91 in the hips treated with PAO.
This technique was originally described by Ganz et al. We have described the steps below, including the original technique along with some of our personal preferences. The patient is placed in a lateral decubitus position using a Stulberg lateral positioner on a radiolucent table. A modified Gibson incision is used to expose and divide the interval between the tensor fascia and gluteus maximus. The latter is retracted posteriorly to expose the posterior border of gluteus medius. An extra-articular trochanteric flip osteotomy is performed, running from the lateral margin of the piriformis fossa to the vastus lateralis ridge.
The blood supply to the femoral head is mainly from the deep branch of the medial femoral circumflex artery [ 76 , 77 ] and is protected by preserving the short external rotators of the hip. The osteotomised fragment should have a small sleeve of the gluteus medius and vastus lateralis attached, and is retracted anteriorly to expose the capsule. A Z-shaped capsulotomy is made to expose the hip joint and the femoral head can be dislocated anterosuperiorly Fig.
Femoral osteochondroplasty is performed with or without the use of intra-operative templates to remove the cam lesion to restore the femoral neck clearance and permit impingement-free ROM of the hip. The need for intervention on the acetabular rim is dependent on whether there is anterior over coverage and the extent of labral and articular cartilage damage [ 44 ].
We use a morphologic system to document the severity and location of labral and cartilage damage in all cases. If anterior overcoverage is present, osteoplasty can be performed from the anterosuperior rim using an osteotome or a high-speed burr after carefully detaching the labrum. Up to 1. The labrum has an important role in the normal hip function; therefore, it should be preserved as much as possible and only be excised if it is ossified, extensively scarred, or degenerated [ 44 ].
The capsular edges should be loosely approximated with absorbable sutures, as overtightening may compromise the retinacular perfusion due to kinking of the vessels [ 78 ]. The trochanteric osteotomy is fixed using two our preference or three cortical screws centred in the osteotomy fragment and aimed towards the lesser trochanter [ 16 ]. Procedures such as relative femoral neck lengthening and femoral neck osteotomy can be performed in combination if osteochondroplasty alone is not adequate to prevent impingement [ 6 , 45 , 71 ].
Post-operatively, most studies advocate a period of 6—8 weeks of toe-touch weight-bearing [ 6 , 11 , 44 , 45 ]. Our personal protocol is toe-touch weight-bearing for 6 weeks, followed by gradual increase in weight-bearing to full weight-bearing over a 2-week period, with hip strengthening exercises starting at 6 weeks. In a mixed series of young adults and older patients, Sink et al. This study included hips in patients, with mean age of 26 years range 8—61 years. The patients were followed up for an average of 5. They reported no cases of osteonecrosis, femoral neck fracture or any complication leading to long-term morbidity.
There was one sciatic nerve injury, which partially resolved. Hip arthroscopy is commonly performed under general anaesthesia, with the patient positioned supine or in the lateral decubitus position [ 80 , 81 ]. The choice of position simply depends on the preference of the operating surgeon, but the lateral approach may be preferable in severely obese patients [ 81 ]. The hip joint has a central compartment where the labrum, femoral head and acetabular cartilage, amongst other structures, can be visualised and a peripheral compartment where the femoral head—neck junction is seen [ 82 , 83 ].
A standard fracture table and a heavily padded perineal post are needed in order to achieve effective joint space distraction. The perineal post should be lateralised against the medial thigh to achieve the optimal traction vector and to reduce direct pressure on the perineum and pudendal nerve. Standard portals include anterolateral, posterolateral and anterior.
Both anterolateral and posterolateral portals are placed along the superior margin of the greater trochanter at the anterior and posterior borders, respectively. The anterior portal is sited where a sagittal line extending distally from the anterior superior iliac spine intersects a transverse line across the tip of the greater trochanter [ 84 ]. We prefer to use a distal mid-anterior portal as our second portal following the anterolateral portal, which is sited midway between the anterior and anterolateral in order to avoid branches of the lateral femoral cutaneous nerve.
Using an image intensifier, a spinal needle is inserted into the hip joint anterolaterally to distend the joint with fluid before a trochar is introduced. The procedure usually begins with inspection of the central compartment. Pincer lesions are typically identified in the superior acetabular quadrant [ 4 ], which can be trimmed if moderate or large using a motorised burr [ 85 ]. Small pincer lesions 2—3 mm may not require trimming, as the treatment of the cam lesion may relieve the impingement [ 86 ].
Damaged labrum may be debrided until stable or repaired, depending on the nature of the damage. Detached and peripheral mid-substance tears can be repaired using suture anchors [ 85 , 87 ]. The condition of the acetabular cartilage should be assessed and can be graded using various classification systems, including the Outerbridge system [ 88 ].
If sub-chondral bone is exposed, micro-fracture may be performed [ 89 ]. The traction should be released once central compartment assessment is completed. He relaxed for a moment, his shoulders rolling, and then went back to swinging his hammer. I was ready to stay there and watch your pound out that poker all day, but unfortunately or fortunately for you, perhaps my friends were too antsy to continue our vigil. I felt ready for a snack. I waited in line, reading the menu painted artfully on the side of a trailer.
It was no use, I already knew what I came for. The county fair is the only place where you can get thick-cut french fries served to you hot, fresh and greasy in a cardboard dog bowl. Oh, but eating them at the base of a ferris wheel makes it worth the price! I was next in line before I looked up and saw you. You were wiping sweat from your brow with your forearm. There was a tattoo of a shark there. In its jaws, a seal looked out at me with a look of terror and resignation.
Like that seal, I too was doomed. Your hair was pulled back in a ponytail.
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Your shirt was soaked through with sweat. The Works. I stepped aside and watched you work on my order. You were doughy and had an earring with a cross on it. You looked like a school yard bully, grown-up — a little dumb, but plenty cunning. You certainly knew your way around a foot-long. It took seconds to layer the toppings and wrap it in paper. You quoted me the price while handing me my dog-bowl — the hot dog perched precariously on top. It came to fifteen dollars.
I gave you a twenty. Before you could turn away, I told you to keep the change. You smiled wide, your eyes closing with the effort. I fell completely.
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I could see the appeal of those older men selling dreamcatchers. I appreciated the quiet dignity of lanky livestock farmers and Native American flute players. The rest of the afternoon was a blur. Everywhere I looked was pure honey and I could not get enough. We were almost free. I needed a respite from my own unhinged libido. We were nearly through the midway, when I was stopped in my path…. I forgot about the roughest of the roughnecks: the game keepers.
Oh, you are a trickster, Sexy Carney. You lured me in with your tight jeans and ample bulge. I know why that game counter is so low. It was not lost on me how well it showcases your finer attributes. Clever ruse. You know that I cannot resist staring at your ass while you stretch and reach and struggle to retrieve my thugged-out Bugs Bunny plushie. You are begging for my attention.
The platonic lady-friend I was with had no interest in your prizes. Yet still, like a moth to a flame, I was drawn into orbit. I slapped my tickets on the counter and took your balls in both hands.