Second case of excision of the knee joint, successfully treated / by William Keith.

  • Keith, William, 1802 or 1803-1871.
Date:
[1854]
Catalogue details

Licence: Public Domain Mark

Credit: Second case of excision of the knee joint, successfully treated / by William Keith. Source: Wellcome Collection.

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    EXCISION OF THE KNEE JOINT. John Reith, eet. 14; from Old Machar parish; bulky for his age, with a florid complexion, and of a very scrofulous diathesis, having numerous cica¬ trices of former strumous abscesses on both sides of his neck, both groins, and all round the ankle joint of the right limb ; was admitted into Lazarus Ward, under the care of Dr Keith, on the 8th of May 1854, with disease of the right knee joint, occasioning so much suffering as to render him anxious to have the limb, or at least the joint removed. Physical signs.—The right extremity is wasted, the leg drawn up and fixedly bent at a right angle to the thigh. The knee is greatly enlarged, tender to the touch, and incapable of being moved in any degree, the attempt causing much suffering ; the skin over the whole limb, leg, knee, and thigh, is so dry and scurfy, as to present very much the appearance of icthyosis; there are two openings in the ham, one on each side of the popliteal space, from which a sero-purulent fluid is constantly discharged, and both openings communicate with the knee joint. History.—He states that seven years ago, when jumping from a dyke, he sprained his right ankle joint ; this was followed by a succession of abscesses, the last of which only healed up at the end of three years of constant suffering. Continuing well and at school for two yenrs and a half, he met with an acci¬ dent eighteen months ago, which, bruising the knee, vcas followed by much pain and swelling of the joint. With little done deserving the name of treat¬ ment, six months of confinement to bed elapsed, when abscess from within the joint found exit by one of the openings in the ham, after which he was so much relieved as to be able to go out on crutches, his knee bent up as it is at present. The opening being very imperfect, a fresh collection of matter formed soon after, and burst at the opposite side of the ham, and these for twelve months have continued to discharge daily, the joint all the time much enlarged, tender to the touch, and more or less painful on movement up to the present time. Pulse never under 120. On consultation it was agreed to excise the joint. Wednesday, \1tli May, 10.15 a.m.—Under chloroform ; the joint was opened by the semilunar incision of the late lamented Dr Richard Mackenzie. In lifting up the flap so formed, osseous union, partly accomplished between the femur and patella, had to be broken up. 1 inch and f ths was sawn off the femur, and -fths of an inch from the tibia, making in whole 2 inches of bone removed. The surface of the patella wTas pared and smoothed, and the gela¬ tinous, degenerated, synovial membrane peeled and dissected from the face of the flap. Three small vessels were tied, the limb straightened, and the wound closed by six stitches, was dressed with ointment, compresses, and a many- tailed bandage, and laid into a well-fitting Macintyre’s metal fracture-frame.