Volume 1

A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves.

Date:
1896-1898
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / by Charles B. Ball [and others] ; edited by Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    1171/1206 (page 1129)
    anohylosis of elbow. I am in favour of abandoning all splints in these cases on theoretical and practical grounds, and of trusting for siip[)Ort to abundance of padding of wool round the joint. This gives suliicieixt support to the joint, and what little movement is permitted by the elasticity of the dressing is rather beneficial than otherwise. As to the question of passive movement in such cases, I am in accord with those who hold that this need not be carried out in the way formerly thought necessary. Indeed, it is not required at all at first. But when the wounds have soundly healed the joint may be gently moved in various directions, so far as this movement gives no pain. But the patient should be encouraged to use the joint as soon as ever he can, which will be so soon as it becomes moi’e or less free from pain. Massage will also be of great use at this ])eriod in preventing atrophy of the muscles, and in keeping up the nutrition of the parts during the processes of repair. Osteo-arthritis of the elbow.—This is_ not an uncommon affection in any or all its forms, and much limitation of movement may be the result. Pig. 462.—Extensive Tuberculous Disease of the Elbow Joint involving Epiphyses, encrusting cartilage and synovial membrane. The diagnosis is easy, as a rule, in view of the fact that other joints are usually affected at the same time and to a larger extent, and that the joint, being so exposed, will easily show irregularities of shape and movement. The general and local treatment are the same as for other joints (page 1055). Anchylosis of the elbow.—This condition not infrequently follows upon destructive disease of the joint, and may be a source of great discomfort to the patient. If the anchylosis have taken place at a right angle, the limb may be faii-ly useful for some pur- poses, but is much crippled for all ordinary work. If the union of the bones, on the other hand, have taken place in the straight posi- tion, though the limb may be useful for some handicrafts, the patient is unable to bring the hand to the head and cannot feed himself. In either of these cases the only course to pursue is to perform a classical excision and remove enough bone to ensure that the bond of union following the operation will be only fibrous. It is remarkable what excellent results follow this operation at the present day, a joint being formed almost equal in strength to the natural one. K K