Volume 1

A manual of operative surgery / by Sir Frederick Treves.

  • Sir Frederick Treves, 1st Baronet
Date:
1903
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A manual of operative surgery / by Sir Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    through transversely to reach the joint, and after the excision nnited the two fragments of the bono together with sutures. ]J»r. Fenwick, of Montreal, saws both femur and tibia in a curved line, so as to make them fit together more closely and accurately than they would do otherwise. There is nothing to recommend this operation, while many very cogent arguments may be urged against it. After-treatment.—The after-treatment is of the utmost importance, is tedious, and often surrounded with difficulties. There is a tendency to displacement, and notably to a dis- placement of the tibia backwards. If sound healing do not take place, the limb is worse than useless, and the flail-like limb that may result is of less service to the patient than a good artificial leg. The limb must be put up perfectly straight—i.e., in the position of complete extension—and for the purpose of flxing it many surgeons employ plaster-of-Paris. The rigid dressing formed of this material is not entirely satisfactory. It may exercise an unequal pressure upon the parts, and may lead to oedema, etc. Discharge may find its way between the splint and the limb, the dressing is difficult to remove, and even when large Avindows are provided the inspection of the part can never be so complete as it should be. Such a splint should be provided as will allow the bones, to be kept in good position, will permit of a free inspection and examination of the wound, and will not interfere with dressing and drainage. It is well that the splint should be suspended. Mr. Howard Marsh points out that the plan of firmly bandaging the lower end of the femur to the back splint leads to great swelling about the wound, and materially retards repair. It is apt, also, to induce persistent venous oozing after the operation. To avoid these drawbacks, he employs Gant's splint. This simple splint, mstead of binding the femur down to the level of the tibia, brings the tibia up to the level of the femur, and no tight bandaging is called for. Another splint which answers admirably in the after- treatment of excision of the knee is Howse's splint (described in Guys Hospital Report, 1877, page 503).