Surgical contributions on contraction and hydrarthrosis of the knee joint / by Louis Bauer.

  • Bauer, Louis, 1814-1898.
Date:
[1858]
Catalogue details

Licence: Public Domain Mark

Credit: Surgical contributions on contraction and hydrarthrosis of the knee joint / by Louis Bauer. 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.

    27/40 (page 25)
    A young gentleman, resident of Brooklyn, 21 years of age, of anaemic and feeble appearance, limped on two crutches into my oflSce on the 21st day of October, 1856, and stated, that at the age of 11 years he suffered from a traumatic injury upon his left knee-joint, fol- lowed by a moderate inflammatory affection, extending over a period of three years. The affection, however, being not very painful and causing no deformity, did not seriously interfere with his locomotion. Repeated falls upon the said joint, and a blow with a hammer, increas- ed the disease of the joint to such a degree as to render him incapa- ble of walking about, unless supported by crutches. On examination, the affected extremity presented the following ap- pearance: knee-joint immovable; patella adhering to external con- dyle of femur; knee-joint bending inwardly (knock-kneed,) and for- wardly, with rotation of the leg and eversion of the toes; the external circumference of the joint somewhat swollen and excessively painful; the flexor muscles extremely tense and shortened, their tendons raised from the bone. In fi'ont of and superiorly to the knee-joint there was an even and oval distinctly circumscribed tumor, 9 inches in length and about 4 in breadth; its lower extremity terminating about the superior insertion of the capsular ligament of the knee-joint; its upper one ending about the middle of the thigh. The tumor was evidently located below the vagina femoris, and was to the feel of very hard structure; the triceps femoris was displaced and located on the left side of the tumor. The diagnosis of the tumor was to me a difiBcult task, presenting, as it did, some symptoms of chondroid or fibrous tumor, and in other respects that of an encysted liquid, being even and circumscribed. An abscess it could not be, for the subfascial collections of pus assume, by neces- sity, a diffused form, though the firmness of the tumor would not have excluded that diagnosis, as it is well known that the unyielding and firm texture of the fascia constantly obscures fluctuation, and thus endowing every collection of liquid with the character of a hard tu- It cannot be denied, that this accident might have been evaded by postpon- ing the operation, and by putting the constitution in proper condition; and the experience once derived from this case, will exercise, for all future, a sufiBcient influence of my surgical proceedings in like cases. Yet in defence of my action, I may here state, that it is impossible for any surgeon to ascertain, a priori, whether synchondrosis is still extant between the shaft of a bone and its apophysis; whether there is any disproportion in the physical resistance of the former or the pseudo-Dbrous structure of an anchylos- ed joint. Every surgeon has therefore to trust to chances, more or less.