I. A bullet in the popliteal space. II. A case of dilated esophagus : two cases showing the value of the X-rays and at the same time that in the first case they were misleading / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1900
Catalogue details

Licence: In copyright

Credit: I. A bullet in the popliteal space. II. A case of dilated esophagus : two cases showing the value of the X-rays and at the same time that in the first case they were misleading / by W.W. Keen. 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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    G toward the inner side of the spot on the skin at which one of the indicator-balls rested, U inches below this spot, toward the ankle, and imbedded in the tissues to the depth of IJ inches. Both skiagraphs show the bullet close to the bone, but, owing to the flilse projection, so common in all X-ray pictures, it is impossible to say whether the bullet was imbedded in the bone or not. Nothing seemed easier than to cut down at a point so exactly indicated and, by introducing the finger, to detect the bullet at once and remove it with ease. On November 1 in the clinic I proceeded to operate. An in- cision four inches long was made over the spot indicated, but on introducing my finger no trace of such a projectile could be found on the posterior surface of the tibia. I cut down to the bone itself at 3 adjacent points and by means of retractors was able to look at its posterior sur- face very clearly, but no bullet was to be seen. I then explored the posterior surface of the tibia, passing my finger between the popliteal vessels and the bone, all the way to the external border of the tibia and still could not find it. After considerable search I again returned to the original place as shown in the skiagraph. The bone was covered at this point by the fibrous insertion of the semimembranous muscle. After incising this I finally came upon the ball imbedded below the surface of the bone. With a great deal of difficulty I was able to pry out and remove it. I then found a deep cavity in the bone, the edges of which were so sharp that I gnawed them away with the rongeur forceps. After washing out the wound with salt-solution I closed it by interrupted sutures and placed the leg on a posterior splint. His temperature only once reached 99°. Twelve days after the operation he left the hospital with the wound en- tirely healed. Dr. Ames, through whose courtesy I am able to repro- duce the picture, in a letter to me states that he made a fluoroscopic examination and that both that and the x-ray picture apparently showed the bullet in contact