1. The operative treatment in paralytic flail joints. 2. A note on the treatment of injuries about the elbow / by Robert Jones.

  • Jones, Robert, 1857-1933.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: 1. The operative treatment in paralytic flail joints. 2. A note on the treatment of injuries about the elbow / by Robert Jones. 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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    the operative treatment of paralytic FLAIL JOINTS.1 By Robert Jones, F.R.C.S.E., Hon. Surgeon Royal Southern Hospital, Liverpool. I wish to draw attention to but one phase of treatment in connection with the after-effects of polio-myelitis. I allude to what may be called the operative treatment of flail paralytic joints ; joints, in fact, deprived of function by complete, and not partial, paresis of all the muscles governing their movements. The discussion of the treat- ment of limbs less severely affected than this is absorbing, but too comprehensive for the present occasion. Suffice it to say that our leading surgeons are more prone to take a pessimistic view of the limitation of their art in this department than the possibilities warrant, and they are apt to relegate to the physician, functions, which they could themselves infinitely better perform. Within the last ten years I have had under treatment over 600 cases of the effects of polio-myelitis, and of this number a not inconsiderable section exhibited complete paralysis of the muscles influencing movement in both knee and ankle, or in ankle only. The difficulty and expense connected with the purely mechanical treatment of these cases, extending as it does over the whole of a lifetime, will be readily appreciated, and it is this fact as much as any other which helped to persuade me to try and transform the flail limb into a member approximating as closely as possible to the splint which I wished to discard. In a large majority of the so-called complete paralyses of the lower limb the psoas and iliacus muscles are unaffected; and all mechanical means are therefore based, if to be of real use, upon the integrity of these muscles. The knee and ankle are kept fixed, and the psoas muscle is prepared to carry the leg, splint and all. In consequence, we are very apt to find our more weakly paralytics very easily tired by the weight of their support, and so they fail in availing them- selves of the opportunity which presents to strengthen their only pair of muscles of progression. The procedure I intend to bring before your notice is that of anchylosing the knee and of partially anchylosing the ankle, and in support of my practice I append a brief outline of fifteen cases upon which I have operated. These do not comprise all cases up to date, as there are eleven remaining, not included in the list, a sufficient time not having elapsed to render it advisable to publish results, although they promise very well. 1 Read at the British Medical Association Annual Meeting, Bristol, ■°94-