On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard.

  • Hutchinson, Jonathan, 1859-1933.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard. 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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    he makes no mention of any other position in the treat- ment than full extension. In a case recorded by Hamilton/ a doctor’s son sus- tained compound separation^ and it was only after an hour’s vigorous efforts on the father’s part that some sort of reduction was effected. After some necrosis the boy recovered with a shortened leg and an ankylosed knee-joint. It is unnecessary to extend the list further. Examples could be adduced where gangrene of the limbj and even death of the patient, has followed even in simple cases of this displacement, which have been either diagnosed wrongly, or forcibly and unavailingly manipu- lated in the extended position. Thus in the case of a boy aged thirteen, treated by M. Richet,^ the diaphysis projected through a wound; reduction was effected (or supposed to be effected) by violent and prolonged traction and extension, with the aid of a spatula introduced through the wound. This instrument broke, and was replaced by forceps used as a lever. The displacement had recurred before the child’s death on the eighth day from pyaemia. A consideration of these facts must favourably incline sui’geons to adopt any method which promises better results. From the cases we now bring forward we be- lieve it will be found that all such violent manipulation is unnecessary, and that the resection of the diaphysial end will very rarely be required. Of course everything depends on correct diagnosis being made early, and un- fortunately, owing partly to the belief that separation of the epiphyses is too rare an accident to be worthy of careful study, and to the wholly inadequate manner in which the subject is treated in most of the text-books, mistakes in the diagnosis are very apt to occur. The skiagram from which the following figure was made was taken two months after complete separation of the lower epiphysis, and is of particular interest since the 1 ‘ Fractures and Dislocations/ p. 530. 2 ‘ L’Union Mcdicale/ 1876, p. 426.
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