A manual of operative surgery . nited by sutureafter the operation is completed. Langenbeck employs a vertical cut somefive inches in length, which is situated uponthe antero-internal aspect of the joint. Theknife divides the vastus internus half-waybetween the inner edge of the patella andthe internal condyle, and is arrested opposite FIG- 487to the inner tuberosity of the tibia. The bones are dislocated inwards, andremoved. Jeffray, Sedillot, and William Knight Treves employed two verticallateral incisions, dividing the bones by means of a chain-saw or a verynarrow hand-saw. Prof. Kocher adv
A manual of operative surgery . nited by sutureafter the operation is completed. Langenbeck employs a vertical cut somefive inches in length, which is situated uponthe antero-internal aspect of the joint. Theknife divides the vastus internus half-waybetween the inner edge of the patella andthe internal condyle, and is arrested opposite FIG- 487to the inner tuberosity of the tibia. The bones are dislocated inwards, andremoved. Jeffray, Sedillot, and William Knight Treves employed two verticallateral incisions, dividing the bones by means of a chain-saw or a verynarrow hand-saw. Prof. Kocher advocates a vertical incision similar to Langenbecks ;its lower end curves forwards. The insertion of the ligamentumpatellae (the tubercle of the tibia) is reflected by a chisel, and sub-sequently sutured or pegged in place again. The method by a longitudinal incision is difficult and small space is provided, a good view of the interior of the jointcannot be obtained, the removal of all the diseased tissue is less surely. EXCISION OF THEKNEE. Oiliers subperiostealmethod. 776 OPERATIONS ON BONES AND JOINTS [part vii effected, and good drainage cannot be provided for unless a specialdrainage incision be made. (3) Golding Bird preserved the patella, but sawed it through trans-versely to reach the joint, and after the excision united the two frag-ments of the bone together with sutures. Dr. Fenwick, of Montreal,saws both femur and tibia in a curved line, so as to make them fittogether more closely and accurately than they would do is nothing to recommend this method, while many very cogentarguments may be urged against it. After-Treatment.—The after-treatment is of the utmost import-ance, is tedious, and is often surrounded with difficulties. There is atendency to displacement, and notably to a displacement of the tibiabackwards. If sound healing do not take place, the limb is worsethan useless, and the flail-like limb that may result is of less serviceto t
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