Case of excision of the knee-joint / [William Keith].

  • Keith, William, 1802 or 1803-1871.
Date:
[1854]
Catalogue details

Licence: Public Domain Mark

Credit: Case of excision of the knee-joint / [William Keith]. Source: Wellcome Collection.

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    CASE OF EXCISION OF THE KNEE JOINT. In the present state of the question, How far excision of a diseased knee joint is a useful or a warrantable operation ? no apology is deemed neces¬ sary for giving publicity to the annexed case. Tlie patient having been this day discharged cured, the duty next felt to be incumbent is to make known the whole particulars of the case to the profession, with a view to advance the progress of such practice if really an improvement in surgery—or share in the blame if in the end the at¬ tempt should turn out to be a failure—to plant this operation high in the list of those which constitute conservative surgery. John Hay, aged 9, from Old Aberdeen, of small stature, and delicate look, but of a happy and cheerful disposition, was admitted on the 7th November, 1853, into the Royal Infirmary, Aberdeen, with scrofulous disease of the right knee joint, which has existed, better or worse, for twelve months. The leg is fixedly bent on the thigh at an acute angle, the heel almost touching the nates. The knee joint is much enlarged gen¬ erally ; the head of the tibia and condyles of the femur evidently expanded ; the capsu’e of the joint is distended and feels pulpy. There is tenderness on pressure over every part of the joint, and actual pain on any attempt being made at movement or extension. The diseased limb, owing to wasting, looks, as a whole, diminutive beside its fellow^ H is general health is good, though he is reported to have had occasional attacks of di¬ arrhoea within the past three months. His spirit is buoyant, and he earnestly desires to save his limb. November 22.—It was agreed on consultation that excision of the joint should bo practised in his case. On Saturday, 26rH November, 10.30 a.M.—Under chloroform. An incision was made from the inner to the outer condyle of the femur, in a semi-circular line, the point of the flap reaching to the head of the tibia, the ligamentura patellae being there cut through. The flap, including the patella, was dissected from all its connections, to a line fairly above the condyles *, the lateral and crucial ligaments were cut, when the utmost facility presented for sawing off* the condyles of the femur. The articulating surface of the tibia was then sawn off from behind forwards, the line of section not reaching so low as the fibula, — two inches in whole being the exact measure of the two portions of bone removed at the operation. The face of the patella was implicated so far as to have become partially adherent to the trochlea of the femur, and was to some extent denuded of cartilage ; it was therefore smoothed by the removal of a thin slice by the aid of a farrier’s paring knife; the remaining portion of the patella being evidently healthy was allowed to rest in situ. Two small arteries on^y required liga¬ ture. Indeed the operation might be designated as bloodless, so little hemorrhage having occurred. The wound was closed by six stitches, dressed with ointment, com¬ presses, and bandage, and the limb extended to thesti’aight without any difficulty—laid and secured in a well-fitting Macintyre’s metal fracture frame. The whole proceeding may have occupied five minutes. He was put to bed still under the influence of chlo¬ roform. To have eight drops of laudanum so soon as he awakes. 7 o’clock p.M.—Has slept quietly and with little interruption since the operation ; says the limb is quite easy ; not a drop of blood has oozed from the wound. Has taken soup in small quantities, but feels squeamish, probably from the effects of the chloro¬ form. Sunday, November 27 (first day), 7 o’clock, a. m. — Became uneasy and fretful at midnight, and had a second anodyne (eight drops) administered, since which has passed a quiet night, and is still sleeping soundly. To have an egg and tea to breakfast. 10 o’clock, a.m.—Feels easy ; seems well ; took his breakfast with relish. To have soup and chicken to dinner. 2 o’clock, p.m—Is cheerful and easy ; relished his dinner. 7 o’clock, P.M—As at last report. Having sunk into the mattress he lies twisted, and is therefore relaid and squared up. Bowels have not moved since Friday ; give tLre® grains of rhubarb pill to-night,