The operative treatment of genu valgum / by Alexander Ogston.

  • Ogston, Alexander, 1844-1929.
Date:
[1877]
Catalogue details

Licence: Public Domain Mark

Credit: The operative treatment of genu valgum / by Alexander Ogston. Source: Wellcome Collection.

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    the right knee crosses completely over to the left knee, and vice versa, so that a hand can be passed through between the trans¬ posed knees. When he walks, he drags the posterior knee from behind its fellow, makes it circumnavigate the latter, and finally come entirely in front of it, before the weight of the body is trans¬ ferred from the one to the other. The normal slightly outward direction of the tibia is so exaggerated that, when lying on his back, the right leg, in the extended position, forms an angle of 150° with the right thigh, and the left leg an angle of 160° with its thigh. When standing the deformity is greater, owing to the superincumbent weight. In each femur the internal condyle is much elongated, while the external condyle is of normal length, but has its anterior surface so far. absorbed that the patella is no longer retained in position, but is displaced outwards, and rests on the outer surface of the femur, with its inner and outer edges directed respectively forwards and backwards. Both patellse, especially the right, can be pressed inwards to near their normal positions, but immediately slip outwards again. Both lower limbs seem shorter than normal, and on standing the biceps tendon is abnormally rigid and j^rominent in each. When the knees are flexed to somewhat more than a right angle, the deviation outwards of the legs completely disappears, and it is easy to recognise by sight and touch that the internal condyles are elongated to between half and three-quarters of an inch. In this position, too, the patellm are drawn still further backwards, so that they come to rest, not on the femur, but on the outer tuberosity of the tibia; and on the front of the femur the groove between the two condyles can be felt. There exists a knotty thickening of the lower extremities of the tibise, fibulae, radii, and ulnae. The clavicles are unusually curved. The upper part of the sternum is very prominent, and the anterior ends of the ribs are enlarged close to their articulations with the costal cartilages. The spine is somewhat excurved in the lumbar region. The health is otherwise perfect. This deformity was treated for some time by splints and bandaging, until it became evident that such means were utterly futile, and that nothing but an operation could straighten the limbs. In a somewhat similar case, Mr Annandale had recently, in the Edinburgh Infirmary, opened the joint and sawn off the elongated part of the internal condyle under carbolic spray and antiseptic precautions. In the above case, however, it was decided to avoid the large opening into the joint, and substitution of a sawn surface for a smooth cartilaginous facet (both unavoidable in Mr Annan- dale’s operation), by making subcutaneously an oblique division of the elongated condyle, fracturing it off as it were, so that it might be pushed higher up into its normal relation to the outer condyle, and there allowed to unite. It was plain that this should permit