Excision of the knee-joint : a description of a new apparatus for the after treatment : with illustrative cases / by Patrick Heron Watson.

  • Watson Patrick Heron, Sir, 1832-1907.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: Excision of the knee-joint : a description of a new apparatus for the after treatment : with illustrative cases / by Patrick Heron Watson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    formed in connexion with the joint, and discharged itself by lateral and posterior openings. This occurred about a year since. On admission; generally, the patient is extremely feeble and anaemic. His appetite is voracious. He has lately suffered from diarrhoea, and is subject to copious night-sweats. He cannot sleep without opiates. Locally, the knee is bent at nearly a right angle. There are several openings from which purulent matter is copiously discharged, especially from a large aperture on the outer side. A probe introduced at this sinus comes in contact with the posterior surface of the condyles of the femur in a carious condition. The slightest effort to move the limb occasions excruciating pain. After a few days' repose to recover from the exhausting effects of his journey, excision of the knee-joint was performed by the long semilunar flap operation. After laying bare the condyles of the femur, the patella was detached from between the condyles of the femur, by means of the bone-pliers, the flap of soft parts, in- cluding the patella, now turned upwards, was released from its attachments to the soft parts by a few sweeps of the knife. The articulating surface of the femur and tibia were then found partially anchylosed, and all traces of the crucial ligaments gone. The leg- was accordingly forcibly flexed upon the thigh till the heel was brought in contact with the buttock. The extremity of the femur thus exposed, projected from the wound, and was seen to be riddled with worm-eaten cavities. The whole extent of disease, limited by a line passing through the spongy texture of the bone, just above the inner condyloid pit, was removed by a few strokes of a saw, provided with movable back. Space was now obtained to clear the posterior aspect of the head of the tibia, the knife being carried close to the bone, so as to avoid the popliteal artery. A thin slice of the head of the tibia was removed by the saw, applied from behind. The entire extent of bone removed was close upon an inch and a half, but rather less. The rough torn surface of the patella was smoothed by means of the gouge. Five vessels were secured. The limb was temporarily placed upon a common gooch splint, well padded, and secured in its place by roller bandages. The patient