Subcutaneous osteotomy in young children / by Robert WIlliam Parker.

  • Parker, Robert William, -1913.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Subcutaneous osteotomy in young children / by Robert WIlliam Parker. 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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    have been assigned. I have myself seen cases in which I could not demonstrate overgrowth in the condyle ; in two cases now under care, I believe it is due to overgrowth of the internal tuberosity of the tibia; and I have several times seen how curvatures of the long bones may simulate this deformity. Nevertheless, the broad fact remains, that in a large majority of cases, this undue lengthening of the internal condyle is the cause of the deformity. I am the more disposed to regard this as the real source of the disease, because, in highly marked cases even, after the condyle has been loosened, the deformity can always be over- come. We owe an especial acknowledgment to Dr. A. Ogston of Aberdeen for having first applied this knowledge to the purposes of surgery ; for although other operations had from time to time been proposed and undertaken, none were comparable to Ogston's at the time when it was first published. In recording this, we must not forget to mention the obliga- tion we owe to Listerism; without such a protection no surgeon would have ventured thus deliberately to open the largest joint in the body. In the next place, I think that great praise is due to Mr. Reeves for having improved on Ogston, by suggesting a subcutaneous osteotomy; and further, one which may frequently be done without even entering the joint. Personally, I have not adopted Ogston's operation; I have not even done it once. Reeves' modification seems to me a less serious operation, and just as effective. Since its introduction, therefore, I have given up all other operations for uncomplicated genu valgum. In children, I believe it can be performed without entering the joint, for the layer of encrusting cartilage, together with its synovial lining, would stretch rather than crack sharply off, as was probably the case in adults. Fortunately for my patients, I have had no opportunity of putting this opinion to the test of the post mortem room ; but the clinical experience of upwards of twenty-five cases seems to bear me out. Among these cases I have now and then had some effusion into the joint—about three or four times in all. On one occasion, in dividing the condyle, which was very soft, I felt the chisel move too freely, and I anticipated what really occurred—effusion into the joint. Though well marked, it was not very severe, and it quickly yielded to an India-rubber bandage and an ice-bag. I now generally use the carbolic spray at all these operations, and apply a small Lister's dressing to the wound.