Overgrowth of the inner tuberosity of the tibia as a cause of genu valgum : independent of elongated inner condyle of the femur / by John Ewens.

  • Ewens, John.
Date:
1893
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Licence: Public Domain Mark

Credit: Overgrowth of the inner tuberosity of the tibia as a cause of genu valgum : independent of elongated inner condyle of the femur / 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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    There is, however, a smaller number in which the tibial overgrowth is the essential and sole element. That it is comparatively rare, or, at all events, has not been gene- rally recognised, is proved by the silence of some surgical authorities, notably the standard works of Erichsen, Agnew, Mansell Moulin, Bryant, and Bowlby, and the very brief allusion made to by others. Ashurst (vol. vi. page 1052) thus refers to it: “Mr. Barwell says, in exam- ining the tibia one feels the portion of bone for an inch below the knee-joint perfectly normal; just at that distance below the articulation one feels in a well-marked case of knock-knee an angle from which the shin-bone slopes outward.” Mr. Barwell operates in this case by osteotomy of the femur and the tibia. Holmes (“ System of Surgery,” vol. iii. page 825) writes: “ Osteotomy at the knee has been performed from two points of view. The one based upon the belief that in knock-knee the inner condyle is unduly long ; the other on the observed fact that genu valgum is often combined with curvature of both tibia and femur.” Walsham (“Theory and Practice of Surgery,” page 824) says : “ The deformity is variously believed to depend on an overgrowth of the internal condyle of the femur, and a corresponding uprising of the inner tuberosity of the tibia,” and so on for other causes, and he does not allude to the necessity of any operation on the tibia. Dr. MacEwen has referred me to his work on osteotomy, and has kindly quoted for me the following passage from it, page 50: “There is another element found in about one-third of the whole number of cases, consisting of an increase of osseous matter on the inner side of the tibial diaphysis at its proximal extremity, which causes the head to sit askew on the shaft. This tibial deformity when present is so to a small extent, though in a few it forms a prominent feature.” He also states that Billroth and Mickerlitz have noticed the subject. Even this quotation does not indicate it as a sole cause. But Owen (“ Surgical Diseases of Children,” pp. 77, 78) refers to it as an occasional sole cause, but says nothing about an operation on the tibia. Doubtless there are allusions to the subject in other works to which I have not access. It is difficult to say why in some cases of genu valgum the femur should be first and solely involved, and in others the tibia only. I would suggest that, admitting the previous arguments, the condition is determined by some accidental {circumstance, possiblv a blow, or some irritation inducing increased