Orthopedics of childhood / by Willis C. Campbell.

  • Campbell, Willis C. (Willis Cohoon), 1880-1941.
Date:
1927
Catalogue details

Licence: In copyright

Credit: Orthopedics of childhood / by Willis C. Campbell. Source: Wellcome Collection.

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    nately, uncommon in early childhood on account of the preponderance of cartilage. Fixation should not be discontinued until the patient is able to maintain the joint in the most useful position by his own volition, or anky¬ losis is firm and painless. Disposal of fixation apparatus should be gradual, beginning with short intervals, which are increased daily, for malforma¬ tion is possible as a late complication. Under no circumstances should forcible passive motion, so-called brise- ment force, be employed, either with or without anesthesia. Unfortunately, such practices are very common but capable of producing serious damage. Adhesions are more resistant than bony structure, and gross fractures, crush- Fig. 53.—Photograph Showing Method of Instituting Passive Motion in Knee-Joint by Modified Thomas Knee Splint and Overhead Sling. ing of atrophic extremities of the bones and violent reaction within the joint, followed by further organization and stronger adhesions may result. There is no counterpart to brisement force in the treatment of inflamma¬ tory conditions elsewhere in the body—for example, no physician would advise forced feeding in the subacute stage of an acute enteritis. Physiotherapy is a most valuable adjunct, but must be continuously and carefully administered by an expert who appreciates that the restoration of function can be accomplished only by gently applied force and never by sud¬ den and violent movements. In the stage of residual impairment, the active process having ceased from one to many years, the condition is a status, not a pathological entity, just as is the scar of an ancient burn. The problem is purely mechanical, often requiring extensive surgical procedures and various appliances for the correction of deformity and malposition. Even at this late stage, except in those with wide distribution and extensive involvement, material improve-