Hip disease in childhood : with special reference to its treatment by excision / by G. A. Wright.

  • Wright, G. A. (George Arthur), 1851-
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Hip disease in childhood : with special reference to its treatment by excision / by G. A. Wright. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    141/276 (page 117)
    one stick. Holmes thinks nearly, if not quite all, walk painlessly and nimbly.* The committee on hip disease (Clinical Society) reported that the limb is generally less useful after excision than after other modes of careful treatment. I have found that the limb after excision, though necessarily less stable than an anchylosed limb, is generally more useful than the natural cure. Sayre, in his case of osteotomy for anchylosis, describes the reformation of cartilage on the cut surface of the bone,-]- and Oilier, at the Medical Congress in 1881, spoke of regeneration of cartilage taking place after subperiosteal excision of joints (vide also Oilier, Traite des Resections, 1885). Where this occurs it no doubt adds considerably to the mobility of the limb and to its smoothness and durability. Kuster, Israel, and others have recorded cases of more or less perfect remodelling after excision of the hip {vide Canstatt's Jakr., 1883). In my own cases I have not, as a rule, allowed attempts * In 1877 Holmes recorded the after results of three cases of excision. 1. Jas. T., set. 23. Eleven years after operation the whole limb was wasted; there was 3m. shortening, 2in. belonging to the femur, and iin. to the leg; the pelvis reduced the apparent shortening to 2in. The whole trunk was less on the diseased side. Movements were free and painless, with slight clicking. Unable to stand on that leg alone; is weakly, pale, and sedentary in habits, but can walk ordinary distances and do work easily. 2. Louisa S., set. 18. Twelve years after excision. Limb somewhat wasted; 3^in. shortening, all in the thigh. There is good union; can flex and abduct; there is free, painless, passive motion. She can just stand alone on the leg. Her health is good. Her occupation sedentary. 3. Lydia B., set. 15. First operation at two years old. Some bone removed some years after. Real shortening less than 2in. Is very fat. Limb well developed. In flexion the pelvis moves somewhat with thigh. Other movements free and painless. Can stand on limb for five minutes. Walks four miles daily. French, in 1848, excised the hip in a child ten years old. At twenty-two years old there was 3|in. shortening. The bone had been removed below the small trochanter. There was some power of flexion. The limb was atrophied and not of much use; there was an ulcer on the foot. Wolff examined a case of excision ten years after operation which was done at two years old; the boy could jump, play, and do gymnastics; the total shortening was z\ cm. Verhandl. d. deutsch. Gesellsch. filr Chir. xi., Congress S. 121. t Cf. also Sayre's case of nearly complete reformation of the upper end of the femur after excision, in Trans. Med. Cong., 1881.