. Modern surgery, general and operative. o avoid standing upon thediseased extremity. In making an intra-articular injection insert the needlebelow the outer malleolus. When caseation occurs, it is advisable to open thejoint, wash out with normal salt solution, inject iodoform emulsion, sew upthe incision, and put up the ankle-joint in plaster. When there is considerablebone disease, when fistulas exist, when adjacent joints or tendons are diseased,or when joint-disorganization occurs, perform an excision or an erasion. Somecases demand amputation (Symes amputation being preferred by some, amp
. Modern surgery, general and operative. o avoid standing upon thediseased extremity. In making an intra-articular injection insert the needlebelow the outer malleolus. When caseation occurs, it is advisable to open thejoint, wash out with normal salt solution, inject iodoform emulsion, sew upthe incision, and put up the ankle-joint in plaster. When there is considerablebone disease, when fistulas exist, when adjacent joints or tendons are diseased,or when joint-disorganization occurs, perform an excision or an erasion. Somecases demand amputation (Symes amputation being preferred by some, amputa-tion above the ankle being approved by many). Osteoplastic resection is some-times advised (Wladimiroff-Mikulicz operation). Operative treatment ismore satisfactory in children than in adults (Garre). Shoulder-joint disease is not common; it is rare in children but is less rarein adults; it may begin in the synovial membrane, but usually begins in the headof the humerus. The glenoid cavity is rarely attacked. Pain is slight, atrophy. Fig. 447.—Sayres double extension of the knee-joint. of the deltoid and other muscles is noted, the joint is stiff, and the scapulafollows the motions of the humerus. Caries sicca is the usual cause of destruc-tion. In many cases swelling is not obvious, the joint shrinking because ofdestruction of the head of the bone and contraction of the capsule (Senn).Abscess-formation is unusual. If an abscess forms, it may open in the axilla,through the deltoid muscle, or at some far distant point. Shoulder-joint diseaseis frequently complicated by pulmonary tuberculosis. Treatment.—A majority of cases recover by the use of conservative treat-ment, a stiff joint resulting. Put on a shoulder-cap, apply the second roller ofDesault, and hang the hand in a shng. Maintain rest for at least four Gillettes plan is very efficient. It consists in placing in the axilla awedge-shaped pad with the base up. The arm is allowed to hang. Aspirationand
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