Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence.

  • Spence, James, 1812-1882.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence. Source: Wellcome Collection.

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    AMPUTATION AT THE HIP-JOINT. Whilst it is generally admitted that the true principle in regard to amputation for malignant tumours of bone is to amputate beyond the bone affected, yet in the case of the femur, the dread of the immediate risks of amputation at the hip-joint has led practically to the abandonment of the principle, and amputation through, or near the trochanters, in cases of malignant tumour, is often advised, and resorted to, as being safer than disarticulation, unless the growth is so high up as nearly to involve the trochanter. I think this a very serious error, as, I believe, in such tumours, the disease permeates the whole of the medullary and cancellated texture of the femur, and that there is no security for the removal of the disease except in removal of the entire bone, by disarticulation; and from what I have seen of high amputations in the thigh, for malignant tumours, I believe the risks of amputation through or near the trochanters to be as great, if not greater, than those of amputation at the joint. In the latter, the rapidity of performance is greater, the loss of blood less; whilst the risks of pyaemia are certainly less in cases of disarti¬ culation than in amputation through the continuity of a bone, where we have the chances of myelitis, inflammation of the veins of the medullary Haversian canals, and acute necrosis, which are especially liable to occur in the state of the system accompanying malignant disease. In my own practice, out of above one hundred cases of amputation of the thigh, there have been five for malignant tumours of the femur, and of these, four have proved fatal; whilst the successful case was one of amputation at the middle of the femur, for malignant disease of the condyles. The following seems to me a case in point, as being the second in which I have amputated at the hip-joint, for malignant growth of the femur; and in both with success:— Case.—M, W., aged 5 years, was admitted on May 29,1865, into the Royal Infirmary, suffering from a tumour of the right thigh. History.—Patient’s mother states, that about six months previous to admission the child complained occasionally of wandering pains