Professor Volkmann on antiseptic osteotomy.

  • Volkmann, Richard von, 1830-1889.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Professor Volkmann on antiseptic osteotomy. Source: Wellcome Collection.

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    parts in the attempts at reduction, which pain constantly persists until the limb has returned to its old position. A recurrence of the contraction is under such circumstances very common and often altogether unavoidable. Lastly, I will draw attention to another very interesting but hardly recognised form of alteration in the shape of the articular surfaces, which I have almost always observed in cases where con¬ traction of the knee has commenced in early childhood, and has existed ever since. I have had several opportunities of examining this condition pathologically. If far advanced, it renders the straightening even of a partially movable joint impossible. It consists of a prolongation of the condyles of the femur, in the direction of the long axis of the bone, and it is brought about by the overgrowth of the lower part of the articular surface, because it has been released from the pressure of the head of the tibia, and from the weight of the body in walking, as a result of the permanently flexed position of the joint. A longitudinal section of the condyles of the femur assumes in consequence the shape of a long ellipse. As two of my preparations show, this elongation may reach a very extra¬ ordinary degree, and then a condition exists which is easily mistaken for a luxation of the tibia backwards, on account of the great prominence of the condyles of the femur. In such cases, however, a dislocation of this sort is by no means always present; although when it does exist it will greatly favour the development of the condition in question. I am also of opinion that where there is at first a smaller amount of flexion, it will be gradually increased by the growing projection of the condyles, while the contraction in its turn leads to further overgrowth in the femur. But if there be only a slight dislocation or none at all, the continual pressure of the head of the tibia, forced firmly as it is against the lower end of the femur by cicatricial shortening of the ligaments, and contraction of the muscles, prevents the increase of the articular end of the femur in its antero-posterior diameter, and the long egg-shaped condition of the epiphysis is considerably exaggerated by the deficiency of growth in the posterior portion, whilst the head of the tibia at the same time has its development interfered with and remains dwarfed. The accompanying figure (not here reproduced), though rough and diagrammatic, is drawn to scale from a preparation in my pos¬ session, and will serve to illustrate this state of things, and to show that even though the joint is far from obliterated, the contraction is irreducible, because the lateral ligaments would have to be stretched to two or three times their present length, in order to allow the tibia to occupy the same position on the femur that it does when the limb is straight. When, however, the prolongation is less marked, I have seen forcible extension succeed without producing dis¬ location, but accompanied by distinct impaction of the projecting part. The peculiar conditions above described were present in both the following cases treated by osteotomy.