A treatise on orthopaedic surgery / by Royal Whitman.

  • Whitman, Royal.
Date:
1904
Catalogue details

Licence: In copyright

Credit: A treatise on orthopaedic surgery / by Royal Whitman. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    823/882 (page 823)
    The operations for the relief of hemiplegic deformity of the hand have been mentioned. (See page 613.) Tendon Splicing. Division and overlapping of the tendons of paralyzed muscles may be employed with advantage in certain instances. For example, in complete paralysis of all the dorsal flexors of the foot, each tendon may be shortened and attached to the anterior ligament; thus the toe-drop may be remedied or reduced to such an extent that the deformity may interfere but slightly with locomotion. As a rule, however, apparatus must be employed to prevent a recurrence of the deformity unless it be combined with arthrodesis. Arthrodesis. . The removal of the cartilaginous surfaces of articulating bones and thus inducing anchylosis for the relief of paralytic deformi- ties of the foot, was first performed by Albert, of Vienna, in 1878. As applied to the foot, it is of special service in those cases in which practically no muscular power remains, the so- called dangle-foot. It may be of service, also, in cases of less disability, as in equinus or calcaneus, when the patient is unable to provide himself with apparatus or desires to dispense with it. The operation consists in opening the joint and removing the cartilage from the apposed surfaces of the bones, then sewing or nailing them to one another, or simply fixing the parts in a plaster bandage until union has taken place. If the case is one of simple calcaneus or equinus, without lateral deviation, the operation may be limited to the ankle-joint, which may be opened from the back or front side, as seems preferable. As has been stated, the usual incision is about two inches in length over the front of the ankle-joint. The foot is then plantar flexed and the cartilage is thoroughly removed from the articulating surfaces with a thin chisel or knife. The wound is theu closed, and the denuded bones are forced into accurate apposition and fixed by a plaster bandage. As soon as possible the patient is encouraged to use the foot. As a rule, in cases of complete paralysis of the anterior group simple anchylosis at the ankle-joint is not sufficient to pre- vent the toe-drop, and it is well to destroy the mediotarsal joint also. A convenient method is to remove the cartilaginous sur- face of the astragalonavicular and calcaneocuboid articulations, together with a thin wedge of bone, base uppermost. In some instances the tendons of the paralyzed muscles are shortened to