Knee injuries, and how to manage them / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1905
Catalogue details

Licence: In copyright

Credit: Knee injuries, and how to manage them / by De Forest Willard. 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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    blood effusions, or purulent collections to remain until the joint functions have been obliterated. All this could have been prevented by early removal. Of course in severe injuries of the joint, motion may be blocked by bony fragments. By the use of the skiagraph these can be readily detected and should be removed if they pre- vent motion. For the ankylosis following injury and inflammation of the knee-joint, massage and active and passive move- ments are necessary. If the bands are flbrous and for the relief of the stiffness in tendons and periarticular structures following inflammation, forcible movements under anesthesia may be employed judiciously by a sur- geon and will be helpful. It is never wise to carry the movements to an extreme degree at the first effort. I have elsewhere given my views as to the extent and persistence of these movements.^ Loose Bodies.—Loose bodies in the joint may be either cartilaginous, calcareous, fatty, fibrinous, or ossific. They may be free in the joint, or may still re- main attached to the synovial fringe by a slender elon- gated filament. While they remain external to the two opposing joint surfaces they may give little or no trouble, but when caught between the femur and tibia the sudden locking of the joint and the sharp pain is often sufficient to throw the patient to the ground or cause him to faint; sometimes the joint remains in the flexed position ; more frequently a little manipulation of the leg allows the body to slide out and the knee can be again straightened; the consequent traumatism of the synovial lining may be slight, or it may be so severe as to cause much effusion of serum into the joint and into the bursa above the patella. The joint should be placed absolutely at rest in bed until the acute pain has passed, together with local anodyne applications and a plaster cast or other splint. Crutches and adhesive plaster strapping with slight motion should be allowed at the end of a week. Repeti- tions of the accident may be frequent, or a body may hide itself so that a long time will elapse before the bones are placed in such position as to allow it to fall between the surfaces. The Germans very aptly call these bodies “joint mice.” It is not wise to operate upon the joint while in the acute stage. The interval operation is a safer one if thorough asepsis is insured. As the patient frequently acquires great dexterity in discovering the loose body and in extricating it from the joint surfaces, 1 Knee Ankylosis, Pennsylvania Medical Journal, January, 1905.