Surgical contributions on contraction and hydrarthrosis of the knee joint / by Louis Bauer.

  • Bauer, Louis, 1814-1898.
Date:
[1858]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical contributions on contraction and hydrarthrosis of the knee joint / by Louis Bauer. 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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    In order positively to prevent the entrance of air, it is necessary to make the serum issue from the joint with velocity, and without interrup- tion, until the last drop has been removed. To accomplish this object, the limb should be brought into a straight position previous to the op- eration, which has the advantage in closing up a part of the articular cavity between femur and tibia, and in forcing the whole contents into the anterior space of the synovial sac. This can be mostly done without any dilBculty, in as far as there are but rarely retractions of the flexor muscles, and never articular adhesions. In case, however., an angular contraction of the joint should exist, it should be removed previous to the treatment of hydrarthrosis, either by gradual exten- sion, or, mare expeditiously, by tenotomy. ' Assuming the extremity is brought to full extension, Tbeden's band- age should be applied from the toes upwards to a point immediately below the protuberance of the tibia. Next igraduated compresses should be placed in the popliteal space, along the ligamentum patellae, and the latter itself, and they should be firmly fastened by ascending adhesive straps, surrounding the whole joint. This proceeding drives the entire liquid into the cul-de-sac of the synovial membrane, and re-j tains it there under great pressure. If tlie articular ca,vity thus .pre^ pared is punctured or subcutaneously incised, its ooflietits/will escape with such vehemence as to render the entrance oif,, ^ir positively iifl; possible. Whilst the liquid is thus escaping from the joint a finger should move across the cul-de-sac towards the wound, in order to close it in the very moment that the liquid stops to flow, whilst the .o]t|ipr hand removes the canula. Such -is tlie mo.de of. preparing the jofp^t, ^I have adopted in my cases, and I can state here, that .1 not only facili- tated the operation thereby, but rendered the latter perfectly harmle^»_ at least in so far as the entrance of atmospheric air is concerned. , .i , It has beep already remarked that simple puncture or simple subcu-; taneous incision act but as palliatives in removing the articular serun^ for the time being. As in hydrocele, the serum soon reaccumnlateSi, unless other measures arc resorted to, calculated to prevent relapse.^ Thus Larey applied raoxce after puncture, and asserts the cure of an enormous serous collection of the knee-joint by anchylosis, (■?). whereftS Carrier, in Lyons, effectually combined compression with,it, ' In what manner Carrier compresses the joint I do not know, nor am I at all conversant with Malgaigne's proceedings, who, it seems, adopted Car- rier's plan, without meeting, however, with the same satisfactory results; y0t that I do know, that by the'compression of the joint executed iu