On the surgery of the knee-joint and The responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley.

  • Keetley, Charles Bell.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: On the surgery of the knee-joint and The responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    19/76 (page 13)
    joint, cut aponeuroses should be united with buried catgut sutures. Cut ligaments should always be so treated. The crucial ligaments should be spared if possible, and they can be spared in most of the cases fitted for simple erasion. Now as to drainage. Special tubes should be in- serted into the superior synovial pouch. Generally the centre of the joint is best drained towards the side, the tube lying in a channel gouged for it in the surface of one or other condyle. A special lateral or postero-lateral opening may be made for it. This main tube should be large, especially if the joint has suppurated before operation. Indeed, in that case the tubes should all be large and permeate every part of the joint and everywhere the abscess may have burrowed. Secondly, one should not be in a hurry to remove these tubes. A fortnight for a case which is aseptic is not too much. And when a case is septic the tubes should be kept in until the knee is either ankylosed or amputated if it cannot be saved. Endless mischief is done by the eager- ness of inexperienced people to withdraw drainage tubes. With the use of sublimated wood-wool or turf-moss pads, and firm bandaging and strapping, aseptic cases will heal under one dressing, but a pedantic desire to obtain this is to be deprecated. If pain or a rise of temperature occur, and cannot be plainly referred to some obvious or removable cause, it is best to dress at once. Recurrent and secondary haemorrhage used to be particularly frequent after excision of the knee. I always bandage the turf-moss or wood-wool pads