On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard.

  • Hutchinson, Jonathan, 1859-1933.
Date:
[1899]
Catalogue details

Licence: Public Domain Mark

Credit: On an improved method of treatment of separation of the lower epiphysis of the femur / by J. Hutchinson, jun. and H.L. Barnard. 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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    pull of the crucial ligaments. It is then somewhat drawn up by tlie quadriceps extensor muscle. The thick peri- osteum is stripped up from the front of the femur for tAvo or three inches, and remains attached to the epiphysis, giving it a forward tilt, so that its articular surface looks downwards and forwards. It will also be seen that the posterior edge of the lower end of the diaphysis is sharp and angular, and projects into the popliteal space peril- ously near the skin, and pressing on the vessels and nerves. Our method of reduction Avas devised to make the epiphysis retrace its steps backAvards, to apply the separated periosteum to the anterior surface of the femur, to withdraw the end of the diaphysis from the popliteal space, and Avhen these objects have been attained to so fix the limb that the displacement cannot recur. The method is as folloAvs : Under complete anmsthesia an assistant makes steady but strong traction upon the tibia in the line of the limb. This overcomes the upward pull of the quadriceps extensor, and brings the epiphysis down to the line of separation. The operator then clasps his hands beneath the thigh and draws it steadily upwards, gradually fexing com-pletely the knee and hip-joint. It will be seen that this manoeuvre causes the epiphysis to move back upon the fractured surface of the diaphysis until it has reached its normal position, and further move- ment is prevented by the periosteum coming into tight contact with the anterior surface of the femur (see Fig. 1). A domette bandage is then applied around the thigh and ankle, fixing the heel upon the buttock, and the limb is laid upon its outer side on a pillow. An ice-bag can conveniently rest upon the front of the knee to limit effu- sion. The advantages of maintaining this position for a fortnight are these :—The quadriceps exerts tension in the length of the bone, keeping the surfaces in close apposition and squeezing out effused blood. The tendon