Series of twelve bone and joint cases : illustrating recent improvement in the mechanical surgery of the lower limb / by Rushton Parker.

Parker, Rushton, 1847-1932.

Date:: 1884

Credit: Series of twelve bone and joint cases : illustrating recent improvement in the mechanical surgery of the lower limb / by Rushton Parker. 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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$[Medical Times and Gazette, Dec. 29, 1883.] Case 9.—Twist of Lower Limb, corrected by Fracture of Femur and Rotation of Lower Fragment with the attached Leg. James Y., aged ten, under treatment since January, 1878, for the correction of double knock-knee of an extreme kind. The left limb had already been straightened by gradual extension and lateral compression with bandages on a Thomas’s knee-splint; the right was also straight; and both limbs were now in calliper knee-splints with boots attached, but the front of the right knee-joint was turned outwards, and the inner condyle looking forwards. Both tibise were compressed laterally and curved in a rickety fashion, but the right was flexible, while the left was rigid. It was thought that fracture of the femur would permit the knee- joint to be turned round to its proper attitude, while the softness of the tibia would permit this to be done without twisting the foot inwards or even breaking the tibia. The knee was accordingly fixed with sheet-iron padded splints, as in Case 8, and the patient put under the influence of ether on January 24,1880. The femur was without difficulty broken, a little below its middle, across the edge of the operating-table, and the lower fragment forcibly twisted inwards rather more than was absolutely required, until the knee-joint occupied, without elastic recoil, its proper position, with the patella forwards. The foot was mean- while easily maintained in its former proper position, owing to the flexibility and thinness of the lower third of the tibia. The limb was put up in Thomas’s longer knee bed- splint, with side plasters, short splints of sheet-iron, etc., as in the preceding cases of fractured thigh. An excellent union, without noticeable incident, had re- sulted by March 15 of the same year, when a calliper splint, made of full length so as to take a portion of the weight of the body, was replaced.$