Spontaneous dislocation of left hip joint, occuring in the course of scarlatinal rheumatism : complicated with necrosis of right tibia, and partial dislocation of right knee backwards / by John Ewens.

  • Ewens, John.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Spontaneous dislocation of left hip joint, occuring in the course of scarlatinal rheumatism : complicated with necrosis of right tibia, and partial dislocation of right knee backwards / by John Ewens. 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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    SPONTANEOU JOINT OCCUR OF LEFT HIP E OF SCARLATINAL RHEUMATISM, COMPLICATED WITH NECROSIS OF RIGHT TIBIA, AND PARTIAL DISLOCATION OF RIGHT KNEE BACKWARDS. By John Ewens, L.R.C.S. Ed., L.R.C.P. Lond., L.S.A., E. S , aet. eleven years, admitted into the Bristol Hospital for Children on March ioth, 1890, with disloca- tion on dorsum ilii of left femur, extensive necrosis of right tibia, and consequent dislocation backwards on femoral condyles, knee being ankylosed (fibrous) at an angle of forty-five degrees. He was in a very weak state, and the skin had scarcely finished peeling after scarlatina, therefore he was placed in the scarlet fever ward, and kept there until the beginning of May, when desquamation had completed. Palliative treatment of the tibia was adopted ; wound kept moist with carbolic acid lotion, and gradual extension of knee was attempted. He was then quite unable to stand without support, and Fig. 1 gives a fair representation of his appearance at that time. History given as follows: On October 23rd, 1889, the boy complained of pain in the right knee, and began to limp. The knee swelled, and was “ lanced ” by the local doctor. Early in November scarlet fever developed, and during this illness he complained also of pain in his left lower limb, but not localised, the limb gradually getting distorted. The right knee was said not to have been painful during the illness. No other joint affected. Two bed sores had formed, one behind the left trochanter, and one below and behind antero-superior spinous process of the ilium. Scars only remain, and there is no evidence of “morbus coxae.” The fever lasted a month, and he had a very bad throat. In June, 1890, the tibia was freely gouged, and large quantities of sequestra were removed, the case progressing most favourably, new bone readily forming. On September 2nd the notes made by Mr. Morton, surgical registrar and pathologist, are as follows : Boy seems now in fair health. Right knee flexed at 450, with some slight lateral and backward displacement. No move- ment of joint possible, and no pain nor tenderness. The SURGEON TO THE BRISTOL HOSPITAL FOR CHILDREN AND WOMEN.