Deformities: a treatise on orthopaedic surgery intended for practitioners and advanced students / by A.H. Tubby.

  • Tubby A. H. (Alfred Herbert), 1862-
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Deformities: a treatise on orthopaedic surgery intended for practitioners and advanced students / by A.H. Tubby. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    always better then to perform open section, as difficulty may arise from haemorrhage. In some cases it is not possible to reduce all the deformity by operation at one sitting, on account of the great tension on the vessels and nerves. It is better in this case to be content at first with partial reposition, and to apply extension by weights for a time, and then proceed again with the division. Osteotomy.—When there is extreme flexion at the hip, and the section of the soft tissues must necessarily be very deep and ex- tensive, it is better to perform Gant’s operation of sub-trochanteric osteotomy. In some cases of paralytic knock-knee, osteotomy may be required. Arthrodesis.—This term is defined as an operation designed to fix a joint in a paralytic case. The object of it is ankylosis, either fibrous or osseous. The latter condition is obtained by com- plete removal of the articular cartilages. The history of the operation is recent. It was first performed by Albert of Vienna, on 20th July 1878, although his claim to priority is disputed by von Lesser. Subsequently Winiwarter, Eied, Ewinger, Keyhier, Wolff, Kirmisson, Eochard, and Eobert Jones have done the operation. At the International Medical Congress at Berlin in 1880 the subject was discussed by Petersen, Lesser, and Bessel- Hagen, who proposed various methods. Arthrodesis is performed either on the ankle or knee - joint, generally the former. Indications for Arthrodesis.— 1. When the paralytic condition is very severe. 2. In poor patients who are unable to provide themselves with apparatus. 3. When the wearing of an apparatus is hadly tolerated and causes pressure sores. 4. It should never be done in spastic cases; nor in paralytic cases after acute febrile disorders, as paralysis, secondary to zymotic diseases, shows a strong tendency to recovery. 5. When two joints in a limb are hopelessly flail - like, it is advisable to fix one or both of them. Method.—At the ankle. Considerable difference of opinion exists as to the most convenient incision, whether it should be anterior, posterior, internal, or external. But the consensus is in favour of the external incision as for excision of the ankle. Against the anterior incision there are urged: the section of the artery, depriva- tion of a foot of a part of its scanty supply of blood, and the