. Manual of operative surgery. n neither on walking nor standing. There is nolateral motion. Remarks.—On reading Lexers most delightful and brilliant article one isreminded of the famous recipe for making hare soup, which began with the wordsfirst catch your hare. It is only fair to state that in Lexers clinic there seemsto be a large number of cases of senile gangrene without phlegmon, and it isfrom that source that he obtains his material for implantations. Juxta- or Supra-articular Osteotomy,—Perkins Operation.—This opera-tion, devised and carried out by J. W. Perkins, is applicable to simi
. Manual of operative surgery. n neither on walking nor standing. There is nolateral motion. Remarks.—On reading Lexers most delightful and brilliant article one isreminded of the famous recipe for making hare soup, which began with the wordsfirst catch your hare. It is only fair to state that in Lexers clinic there seemsto be a large number of cases of senile gangrene without phlegmon, and it isfrom that source that he obtains his material for implantations. Juxta- or Supra-articular Osteotomy,—Perkins Operation.—This opera-tion, devised and carried out by J. W. Perkins, is applicable to similar condi-tions in various articulations, but is perhaps peculiarly appropriate in the principles of the operation are: (a) Avoidance of injury to the articularstructures and, in the young, to the epiphyseal line, (b) Avoidance of injuryto, or undue stretching of, the great vessels and nerves of the popliteal space.(c) Rectification of deformity with retention of any power of movement whichthe joint may Fig. 1309. Fig. 1310. Figs. 1309, 1310, 1311 and 1312. Fig. operation. Fig. 1312. The operation is an extension of the basal principles of Macewen supra-condyloid osteotomy. Example i.—The knee is in a position of flexion; a moderate degree of furtherflexion is possible but no further extension. The structures (ligaments, tendons,vessels, etc.) posterior to the knee are contracted. The Operation.—Step i.—Make a longitudinal incision 2^ to 3 inches inlength down to the bone on the inner side of the thigh. The lower end of thisincision should be about }4 inch above the epiphyseal line. If necessary, makea similar incision on the outer side of the thigh. Step 2.—Separate the periosteum from the bone and retract the soft partsand periosteum together so as to expose a sufficient area of bone. Step 3.—With osteotome, chisel, or saw excise the rhomboid of bone ab, cd(Fig. 1309). The segment of bone removed must be sufficient to permit t
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