. Manual of operative surgery. ehind the external malleolus make an oblique incision do\\Ti to and throughthe periosteum of the os calcis. Brenner prefers to operate on the inner side(H. Riedl, Archiv fur Klin. Chir., xcii, p. 416). Step 2.—With an osteotome divide the os calcis obliquely from above down-wards and forwards. It is well to use a broadbladed osteotome in order toavoid splintering of the bone and to leave a smooth cut surface. As soon as thebone is di\ided cut the periosteum on the inner side of the bone. Completemobility of the posterior fragment of bone is necessary-; if it is n
. Manual of operative surgery. ehind the external malleolus make an oblique incision do\\Ti to and throughthe periosteum of the os calcis. Brenner prefers to operate on the inner side(H. Riedl, Archiv fur Klin. Chir., xcii, p. 416). Step 2.—With an osteotome divide the os calcis obliquely from above down-wards and forwards. It is well to use a broadbladed osteotome in order toavoid splintering of the bone and to leave a smooth cut surface. As soon as thebone is di\ided cut the periosteum on the inner side of the bone. Completemobility of the posterior fragment of bone is necessary-; if it is not mobile someundivided strands of periosteum must be looked for and, when found, cut. Step 3.—Push the fragment of bone downwards, forwards and a trifle inwardsto the desired extent. If valgus is a feature, then the lateral dislocation of thefragment must be more pronounced. The downward displacement should beabout ^ to % inch. If the operation has been properly performed the boneought to tend to stay in its new Fig. 1478.—Brenners modification of Gleichs operation, ir. Eiselsberg.) Step 4.—Hold the bone in position. With a knife or tenotome puncture theskin of the heel over the end of the os calcis. Introduce a drill through the skinpuncture, and fix the fragment of bone in its new position by means of this does not nail the bone. Step 5.—Close the wound without drainage. Apply dressings. Leave thedrill in situ. Immobilize with plaster of Paris in a position of slight supinationand plantar flexion. Remove the elastic constrictor. .?\fter about two weeks remove the drill without taking off all the plaster ofParis. About three weeks after operation renew the plaster of Paris so that thepatient can move about without risk to the calcaneum. Bony union is generallycomplete about six weeks after operation. Figure 1478 shows the result in apatient of v. Eiselsbergs two years after operation. Nicoladonis Operation.—Paralysis of the gastrocnemius i
Size: 1930px × 1295px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
