Lectures on orthopedic surgery . , 1868, and Lewis A. Sayre, in1875. The comparatively recentdate at which this operation wasgenerally accepted may be realizedby an editorial note in Dr. Town-sends translation of VelpeausSurgery, edited by ValentineMott, in 1847. After reviewing theoperation the editor says : Not-withstanding the facts, the questionof tenotomy still remains unde-cided. The operation as performed bymost surgeons in England andAmerica at the present day is prac-tically the same as that recom-mended by Stromeyer in 1831. Itconsists in correcting the lateral deformity (the varus)i
Lectures on orthopedic surgery . , 1868, and Lewis A. Sayre, in1875. The comparatively recentdate at which this operation wasgenerally accepted may be realizedby an editorial note in Dr. Town-sends translation of VelpeausSurgery, edited by ValentineMott, in 1847. After reviewing theoperation the editor says : Not-withstanding the facts, the questionof tenotomy still remains unde-cided. The operation as performed bymost surgeons in England andAmerica at the present day is prac-tically the same as that recom-mended by Stromeyer in 1831. Itconsists in correcting the lateral deformity (the varus)in so far as it is possible before attempting the divisionof the Achilles tendon. The tendon is then divided witha tenotome, a small knife with a short and narrow bladewith a long shank. The tenotome is inserted flat be-neath the tendon, its edge is then turned towards thetendon which it is made to divide by a sawing is taken not to separate the cut ends of the tendonuntil soft union has taken place at the end of from. Fig. 257.—The tenotomesused by Mr, RobertJones. 321 4 to 7 days. Then by manipulation and retention it isattempted to stretch the plastic material which unitesthe cut ends of the tendon until the desired positionhas been gained, the fear being that the cut ends ofthe tendon will not unite if they become too widelyseparated. As early, however, as 1838 Scoutetten ad-vised the immediate correction of the deformity aftertenotomy, and this for many years has been practisedby Say re, in New York, and R. W. Parker, in distant separation of the cut ends of the tendondoes not of itself cause nonunion we are sure, havingobtained solid union where the separation, in a youngwoman, was If inches. Another fault in the old operation was the attemptat correction of the lateral deformity before the antero-posterior defect had been remedied. As pointed out inthe remarks on the anatomy of clubfoot the body ofthe astragulus is often wedge shaped, with the ap
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectorthopedics, bookyear
