The surgical treatment of the diseases of infancy and childhood / by T. Holmes.
- Timothy Holmes
- Date:
- 1868
Licence: Public Domain Mark
Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.
432/700
![31)2 [Fip. 60. The entire diaphysis of the tibia successfully removed by subperiosteal resection (William Steel). The line a is where the chain-saw was applied.] easily removed by twisting it gently with a strong pair of forceps, and thus the whole diaphysis of the bone, measuring 7£ in., was taken out of its periosteal sheath. It is shown in fig. 60. It will be noticed that some portions of periosteal bone are de- posited on the shaft, and a few small frag- ments of periosteum came away with it. On examining the latter, however, after the removal of the bone, it was seen to be in all essential respects healthy. The bleeding was not formidable. The cavity was filled with a large piece of dry lint, and the edges of the wound lightly ap- proximated. His general condition rapidly improved after the operation—the pulse became stronger, the appetite better, and the pain ceased. Abscesses formed in the immediate vicinity of the knee, and were opened. They were thought not to be within the articulation, since the patella was easily movable, and without pain. The limb was put up in a Macintyre's splint, and no shortening was apprehended —for it was thought the fibula would act as a stay, preventing the approximation of the foot to the knee. But, probably from the abscess having destroyed the up- per tibiofibular articulation, a very marked diminution in the length of the limb was discovered about six weeks after the oper- ation : attempts were made to elongate it by extension in an Assalini's box, but after the boy's recovery If in. of shortening still remained ; the operated limb measuring 12| in. from the upper border of the pa- tella to the sole of the foot, and the sound limb 14 inches. There remained also com- plete stiffness of the knee. His recovery was uninterrupted, and he went to Mar- gate on Oct. 2. He returned to town, and was shown to the Western Med. and Surg. Soc. on December 1. He could then walk quite well with a stick: there were a couple of sinuses which still led to ex- posed bone. These were afterwards laid open, and the bone found to be perfectly solid and alive below them. I believe](https://iiif.wellcomecollection.org/image/b20416325_0432.jp2/full/800%2C/0/default.jpg)
