Rickets, its treatment by osteotomy : a clinical lecture delivered at Bellevue Hospital / by Frederic S. Dennis ; reported by Thomas McCann ; and revised by the author for Gaillard's Medical Journal.

  • Dennis, Frederic S. (Frederic Shepard), 1850-1934.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Rickets, its treatment by osteotomy : a clinical lecture delivered at Bellevue Hospital / by Frederic S. Dennis ; reported by Thomas McCann ; and revised by the author for Gaillard's Medical Journal. 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.

    7/10 (page 7)
    be performed. The technique of the operation itself may be divided, for convenience of description, into four stages, and a description of it will include the application of the permanent dressing to thewound. The first stage consists of the incision through the skin down to the bone. The second stage includes the section and fracture of the bone. The third stage comprises the correction of the deformity and the dressing of the wound. The fourth stage embraces the application of a permanent dressing. In the first stage the incision should be made by pushing the point of the scalpel straight down to the bone and cutting the skin, which should be firmly held between the thumb and index finger of the sur- geon. The skin incision should be longitudinal and only sufficient to per- mit the chisel to be placed upon the bone, and any incision larger than this only adds a danger, by more fully exposing the seat of fracture. The incision should be squarely upon the centre of the shaft at the pointwhere the bone is to be fractured. No vessels are wounded, and care should be exercised lest a tendon be injured or the knife slip off the bone. The second stage now begins, and consists of placing the osteotome upon the bone and through the small skin incision. The edge of the osteotome must not overlap the side of the bone, and the direction of it must be away from the main artery lying in close juxtaposition to the bone. The handle of the osteotome must be held tightly, and the mallet should strike firm blows upon the head of the osteotome. When the chisel has traversed about half the diameter of the bone it should be removed, and the smaller chisel should be inserted into the centre of the track of the first chisel, and the instrument can be safely hammered, as the blade can not come in contact with any soft structures, because the blade of the second chisel is narrower than the first chisel, and the sides of the bone itself prevents any accident. This can divide the bone still further, and then the chisel should be removed and a clean, small, antiseptic sponge placed over the wound while the surgeon attempts to break the bone. There is great protection in the use of the second and smaller osteotome; because, otherwise the first chisel is tightly held in the bone, and in extracting it the cutting edge of the chisel may break- off and be left in the bone. This accident has occurred to me twice in badly tempered chisels; but in both cases no harm arose, though a good sized piece of steel was left imbedded in the bone, and could not be removed. This accident will not occur if the second chisel is used in the manner described. The bone should not be entirely cut through with the chisel, but only three-fourths of its diameter, and then it will fracture without splintering. It is not well, on the other hand, to attempt by violence to fracture the bone if the chisel has not tra-i