Osteotomy generally : with special reference to tarsectomy in advanced and intractable cases of talipes equino-varus : read in the Section for Diseases of Children at the Annual Meeting of the British Medical Association held in Bournemouth, July, 1891 / by John Ewens.

  • Ewens, John.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Osteotomy generally : with special reference to tarsectomy in advanced and intractable cases of talipes equino-varus : read in the Section for Diseases of Children at the Annual Meeting of the British Medical Association held in Bournemouth, July, 1891 / by John Ewens. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    as I have never yet succeeded in fracturing the fibula by manual effort, and it is an obstruction to the proper position of the tibia, I always commence the operation by partially dividing it with a narrow chisel, and then fracturing it with or after the tibia. The results in these cases are most satis- factory. The limb must be swung and treated as an ordinary compound fracture of tibia. Talipes Equino-Vajrus. The intrauterine development and subsequent history of this affection were so fully dealt with in the most interesting papers read in 1888 before the Glasgow meeting of this Society that any attempt on my part in a similar direction is simply unnecessary and quite foreign to my purpose at the present time, my object being chiefly to combat some objections which have been raised against tarsectomy on the ground of danger and insufficiency, and the argument that the operation is unnecessary under 10 or 12 years of age, and feet can be quite as easily rectified by plaster and instru- mental appliances. To this last statement I readily assent up to a certain age, granted that expense and time are not of material consideration; but to the bulk of cases which come under the care of a country hospital surgeon both of these are very important factors in the consideration of the subject, all such being able at most to provide an ordinary steel support to maintain the position of the foot effected by the operation. Complicated machinery with screw and rack apparatus, and pads to guard against undue pressure, would be far too expensive, even supposing the attendants, parents, and others possessed the intelligence needed to regulate these things proportionately, and in country districts where no skilled mechanic can be obtained the thing would be practically useless. Here the quotation read just now from Mr. Davy’s pamphlet applies with special force. And when we consider the time occupied in treating such cases by plaster and the constant tendency to relapse, I think the preference must in every way be conceded to tarsectomy. If a case goes on uninterruptedly well, a plaster casing may be put on in the course of four or six weeks, and in another month light steel supports can be very well supplied. The cut surfaces of the bone after the wedge has been removed soon unite, and consolidation is efficiently established, thereby with ordinary care removing at least one of the conditions favourable to relapse—for example, excess of bony growth. I am informed by Mr. William Adams that the operation as originally designed by Dr. Little, though never performed by him, was first performed by the late Mr. Solly, of St. Thomas’s Hospital, in 1854, and consisted in removal of the cuboid bone, and my first operations were commenced with that intention, but I always found it necessary to remove more bone so as to bring the parts into position. Mr. Lund, at the Glasgow discussion, advocated removal of the astragalus, and he has courteously sent me his pamphlet, being a reprint of a paper read by him at the Birmingham meeting in 1872. His result appears to be very good. I am indebted to the kindness of his son, Mr. Herbert Lund, for the privilege of showing some casts and photo- graphs of cases recently operated on by himself, which I am sure we shall all admit are very satisfactory. But in the eleven cases occurring in my own practice at the