Osteotomy generally : with special reference to tarsectomy in advanced and intractable cases of talipes equino-varus : read in the Section for Diseases of Children at the Annual Meeting of the British Medical Association held in Bournemouth, July, 1891 / by John Ewens.

Ewens, John.

Date:: 1891

Credit: Osteotomy generally : with special reference to tarsectomy in advanced and intractable cases of talipes equino-varus : read in the Section for Diseases of Children at the Annual Meeting of the British Medical Association held in Bournemouth, July, 1891 / by John Ewens. 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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$apex being well arranged for previous to operation—has been removed; and I must admit that I have made the mistake of not taking a sufficiently large wedge in one of my earliest casesf the left foot requiring a second operation. It is better to take away rather too much than too little bone, and let the wedge be complete and broken up as little as possible. As a rule, the parts removed will be found to be portions of calcis and cuboid, with the head of the astragalus and scaphoid. It has also been suggested to remedy the deformity by fractur- ing the tibia and fibula above the ankle; but this appears to be creating one deformity to remedy another, and must surely render the bones liable to fracture on very slight injury (Dr. Ogston, at Glasgow, 1888). I here append woodcuts of one of my recent cases before, and several weeks after, operation. The child was 6 years old. (See Figs. 1 and 2.) Dangers of the Operation now to be Considered— Of fifteen cases of tarsectomy by myself and colleagues, I am happy to say we have no fatal case to report. It would be too much to say that I have never met with any cases causing consider- able anxiety, and in two or three instances suppuration has taken place; yet this has usually been traceable to some cause not necessarily due to the operation, and where doubt- less some antiseptic precaution has been overlooked. These cases have all occurred in my own practice, and I do not ex- pect such results in the future, having, I believe, detected the flaw. It is most important to remove hardened skin by means of glycerine and liq. potassse, with constant soaking in carbolised wet lint. - Cases of talipes, as far as my observation goes, occur in children not naturally of a strumous constitution, and there- fore the dangers which would ordinarily ensue. m an opera- tion involving suppuration amongst the tarsal bones are very much diminished, and I have never seen the patient s life threatened, either in this or any other osteotomy, winch, however simple (for example, of the tibia), may occasionally ^And*here I have much pleasure in stating that out of twenty-nine operations for genu valgum and curved tibiae and femora performed by myself and colleagues in the Bristol Children’s Hospital within the last three anda-k vears and as large a proportionate number during the past te^years, not a fatal case, nor one causing special anxiety, lmAoeGlTwMch the Operation should be Performed.-Some speakers at the Glasgow discussion went so far as to condemn the operation in any case under 12 yeais of age. Ihis wouia practically remove it from the list of surgical operations oi children, as I presume all children’s hospitals limit t ie age ( i mica inn fr> 12 vears • but I quite fail to see the rationale of allowing so unsightly a deformity to exist for twelve years if every other recognised method—tenotomy, plaster, appa- ratus Ttc-either have failed or are otherwise inadmissible, r„ftegrCiuad of time, expense etc I do.not now deri w‘th the question of tenotomy in early life. No educated surgeon nf flip nrpspnt dav would, I imagine, allow an infant to leaefi the age of 3 months without either tenotomising every con- tacted tendon, or putting on a isuitable apparal becomes a serious question how far one would be ]ustified m allowing a child to grow up beyond the age of o years,, wnen ft is evfdent^ that the bon/ deformity is so great as to defy$