Rickety deformities of the lower extremity : their treatment by operation / by Edmund Owen.

  • Owen, Edmund, 1847-1915.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: Rickety deformities of the lower extremity : their treatment by operation / by Edmund Owen. 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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    way through. Sometimes, when the bone is very hard, the first attempt which is then made of breaking the bone fails, and the saw has again to be introduced. If both limbs require operation, the second is treated before the first is permanently dressed ; they are then fixed straiglit in a box-splint or in a Bavarian dressing. Of the objection to the presence of sawdust in the wound we know nothing in practice, though in theory it is often raised. The saw has a rather short and thin blade and a simple flat handle. The long stalk-bladed saw, which has been specially designed for subcutaneous osteotomy, is by no means suited for section of the lower end of the femur, or of the shaft of the tibia, in the case of a child. For a leg which is bowed laterally, or possesses that antero- posterior and extreme curve w'hich is so often found a little above the ankle of a rickety child, and which refuses to yield to forcible manipulation, osteotomy with the saw is likewise easity performed. A direct incision is made down to the inner surface of the tibia and the bone is sawn about half-way through and then broken. It may even then be prevented from coming perfectly straight by the tendon of Achilles, which may have been stretched like a bow-string in the concavity of a curve ; instruments should therefore alway^s be at hand for performing tenotomy. And when the bent fibula is a check to the straightening of the bowed but severed tibia, it is easily snapped through at about its middle by giving it a sudden sharp bend. However great an antero-posterior or a lateral curvature of the leg-bones may be in childhood, it is, as a general rule, superfluous to remove a wedge-shaped piece of bone from the convexity of the bend. A simple direct incision into the bone, and fracture of the undivided tissue suffice, for after the creation of this complete compound fracture it is advisable, if not absolutely necessary, to keep the child off his feet for several months, lest the soft uniting cement also yield and the deformity become as bad as or worse than ever. During these months of perfect rest the slight deformity wdiich remained when the limb was put up after the operation gradually fades away. The fibula breaks through so easily with a properly applied and sudden jerk that osteotomy of its shaft can rarely