. Manual of operative surgery. fibula was transferred with a portion of tibialis anticus muscle. Close thewound. Dress. Immobilize. In time there is liable to be a bowing of thefoot on the fibula causing a deformity. This led Huntington after the lapse of six months to perform a secondoperation as follows: Expose the upper end of the lower fragment of it. Divide the fibula at about the same level. Unite the fibula to thetibia. Close the wound. Dress. Immobilize. QIO UNUNITED FRACTURE. PSEUDARTHROSIS Several brilliant results have been obtained by Huntingtons
. Manual of operative surgery. fibula was transferred with a portion of tibialis anticus muscle. Close thewound. Dress. Immobilize. In time there is liable to be a bowing of thefoot on the fibula causing a deformity. This led Huntington after the lapse of six months to perform a secondoperation as follows: Expose the upper end of the lower fragment of it. Divide the fibula at about the same level. Unite the fibula to thetibia. Close the wound. Dress. Immobilize. QIO UNUNITED FRACTURE. PSEUDARTHROSIS Several brilliant results have been obtained by Huntingtons patient walks without a limp—runs and plays foot-ball. 7. J. S. Stone s Operation (Annals Surg., Oct., 1907).—Stones operationis practically identical with Huntingtons except that he assures stability tothe foot in the second operation by having both malleoli attached to the newtibia (Fig. loSbj. First Stage.—Implantation of the upper end of fibula into upper tibialfragment. Identical with Huntingtons operation. 1 1 I i. Fig. 1084.—Before operation. Fig. 1085.—After operation. Figs. 1084 and 1085.—Replacing tibia with fibula. (Codtnan, Annals of Surgery.) Second Stage.—Expose and vivify the upper end of the lower tibial (without injuring the periosteum) the lower 3 inches of the fibula. Dividethe periosteum with a knife. With fine chisel and strong knife split the fibulalongitudinally into two equal parts. In Stones case each half of the bonehad a thickness of only 4 mm., scarcely over an eighth of an inch, yet in separat-ing them for a distance of about 3 inches, 8 cm., it was essential that the peri-osteum remain adherent to each portion and that an equal thickness of eachpart be maintained throughout. It was planned to spread the halves withoutbreaking either. This proved impossible. Fortunately the outer rather thanthe inner half gave way close to the upper end of the split between them. Inanother case it would seem wise to insure a break in th
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