Notes on some points in military orthopaedics / by Robert Jones.

  • Jones, Robert, 1857-1933
Date:
1916
Catalogue details

Licence: In copyright

Credit: Notes on some points in military orthopaedics / by Robert Jones. Source: Wellcome Collection.

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    After- Treatment. In a straightforward case there is no reason why the patient should not get out of bed on to a coucli on the third or fourth day. He should not, however, put his foot to the ground for the first week. The stitches are removed as usual about the tenth day and massage may be com¬ menced, the patient being allowed gradually to bend his knee. Each day he exercises, bending and extending the knee more and more, until in about three weeks he should reach the full range of movement and walk with freedom. In my practice several professional footballers have resumed their game in six or eight weeks after the operation. There is no reason why in suitable cases men should not return to light duty about five weeks after the operation and, if properly exercised, be fit for full duty three weeks from that date. This, however, depends upon the patient being put through a course of carefully graduated movements and exercises through the whole period of his convalescence. Surgeons who have been operating upon soldiers com¬ plain of the weakness in the knee which so often follows operation. This experience is common, but if the opera¬ tion has been properly performed and the after-treatment by massage and exercise has been thorough, these dis appointments will not occur. The surgeon should be assured that the thigh muscles are restored to their normal condi¬ tion, and a patient should not be discharged from hospital until the thigh has attained its normal girth. We must also retain a critical attitude of mind, for some soldiers are keen to remain off duty, and the knee is often only an excuse. Recurrent Effusion into the Knee-joint. Recurrent effusions into the knee-joint are often very puzzling. It is possible, however, to lay down a few rules for guidance. I. After injury of the knee, effusion of fluid into the joint is very liable to occur, and if the patient is kept resting and not using the limb, the effusion will probably recur the first time he lAspt. The patient is again put to bed, but when he gets up effusion reappears. The rational treatment in such cases is to baudage the knee firmly and let him walk, and in the evening there will be some effusion, which will disappear by morning. The knee should again be bandaged and the patient allowed to walk. In the evening there will be still effusion, but not so much as before. By following this routine the joint will gradually become accustomed to the increasing exercise, with a diminishing amount of effusion on each day. This is the real test that a joint which has been injured is really recovering and is fit for gradually increasing exercise. II. The second point is that recurring effusion which increases instead of diminishes under the above careful