This case confirms the views expressed in a paper published in this Journal, two years ago, as to the value of early and extensive resection. Similar evidence from the negative side is afforded by a case I gouged extensively the diseased in which, for cario-necrosis, part ; a temporary cure was followed by recurrence, and eventually waxy disease and death. In another case, very similar to both the above, the joint mischief was more pronounced, and when brought there was a sinus communicating with the joint. Amputation being refused, adopting a German method, with i red hot chisel I punctured in several places the head of the diseased femur, and passed drainage tubes through the joint. The boy was removed, but his friends continue dressing in accordance with my instructions, and I hear that he is impro-

ving.

All the cases I have adduced have been in connection with With regard to the femur I entertain accessible bones. serious doubts as to the advisability of extensive operations, such as gouging and resection, except as an alternative to amputation. I have performed resection twice, but in each case amputation would have been better. Further, my experience of two or three cases leads me to doubt whether gouging is desirable for caries of the distal extremity of the femur. Sequestra too are often difficult to get at. In a recent case the attempt to follow a long sinuous cloaca, so weakened the femur that some weeks afterwards it fractured, and the limb was sacrificed. Although these cases are but few in comparison with those relieved, still they indicate a proportion of risk and of failure which enforces the necessity for great caution in undertaking operative procedures on the femur.

easily

KASHMIR MISSION HOSPITAL CASE OF RESECTION OF TIBIA. Under care of Mr. Arthur Neve. The following case is interesting as showing the conservative value of prompt interference in bone disease. Lussoo, a boy ten years of age, was admitted on May 2, 1883, with illness of 20 days' standing ; an abscess over upper half, of the'tibia and acute inflammation of the knee-joint. Treatment.?Aspiration of the abscess showed the tibia bare in its entire circumference. Two days after, with the kind help of Dr. Tajtffe, Civil Surgeon, resection was performed. The head of the bone was inflamed and softened, so was gouged away close to the cartilage, and the whole upper half of the tibia .removed. The periosteum showed signs of new bone formation. The skin over the joint was freely cauterised. Progress. Ry the 14th May, ten days after, the whole cavity was filled with granulations. Progress was slow owing to overgrowth of granulations ; finally the wound healed, but the cicatrix ?

ulcerated. The most interesting symptoms were those in connection with the. growth of bone. The fibula grew rapidly, and in so doing was dislocated from the tibia, and by its action on the femur forced the' leg inwards. At one time its head threatened to perforate the skin. This was rectified by extension and a

splint.

State

Case of Resection of Tibia.

Case of Resection of Tibia. - PDF Download Free
2MB Sizes 3 Downloads 8 Views