Lectures on orthopaedic surgery : delivered at the Brooklyn Medical and Surgical Institute / by Louis Bauer.

Bauer, Louis, 1814-1898

Date:: 1868

Credit: Lectures on orthopaedic surgery : delivered at the Brooklyn Medical and Surgical Institute / by Louis Bauer. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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$The usefulness of gradual extension in the treatment of fibrous anchylosis is for obvious reasons but limited and conditional, and the attempt to substitute the same for brisement force is a failure. The anatomical conditions resulting from joint disease are but exceptional]}/ amenable to that method ; it is tedious at best, and frequently so painful as not to be borne by many patients. Its claimed superiority is, moreover, anything but conclusive. Nevertheless we meet with cases in which the elastic resistance of intra-articular adhesions and of the capsular ligament can be but overcome by gradual and persistent extension, and in these it seems to be the only remedy. These conditions we recognize only after unsuccessful attempts at brisement force, and the latter has therefore to precede. Such cases may be rare, and constitute but a small fraction in statistics; but they do exist, notwithstanding their denial. I possess two specimens of this very character in my collec- tion, both derived by amputation of the thigh. One belongs to a lady who had contracted fibrous anchylosis of the knee from rheumatic synovitis, aggravated by contraction of the hamstring muscles. Before coming under my charge she had suffered brisement force, without previous division of the contracted flexor muscles. Violent reactive inflammation of the joint followed the forcible extension, and the latter was too painful to be main- tained. The integuments sloughed at the internal circumference of the articulation, and her constitution was so violently shaken that her recovery was placed in jeopardy; and when, after many months of severe suffering, she had regained her strength, she was to all intents and purposes in a worse condition than before the operation. Moreover, the leg was in so high-graded a state of hyperesthesia that she could not bear the slightest touch, and the thickened epidermis was peeling off in large patches. Although desirous of amputation, I deemed it my duty to trj once more brisement force. Assuming that the omission of myo- tomy was the cause of the disastrous failure in the first instance, I divided the contracted hamstring muscles previous to the opera- tion. I met no difficulty in breaking clown the intra-articular impediments, but I exerted my entire physical strength in vain in attempting to fully extend the \eg. I succeeded, perhaps, to an angle of 160°, but could not keep the leg in the same. It 20$