A manual of operative surgery . in the epiphysis (Fig. 434). The position and limits of the lowerepiphysis of the femur are dealt with in thechapter on excision of the knee. It is onlynecessary here to repeat that the epiphysialline is about on a level with the tuberclefor the adductor magnus tendon. Thetrochlear surface of the femur belongs to-the epiphysis. A transverse section of the femur aboutthe epiphysial line will show that the outerpart of the bone is much more extensivethan the inner part (Fig. 435), and this,disproportion is continued for some littledistance upwards in the less expa
A manual of operative surgery . in the epiphysis (Fig. 434). The position and limits of the lowerepiphysis of the femur are dealt with in thechapter on excision of the knee. It is onlynecessary here to repeat that the epiphysialline is about on a level with the tuberclefor the adductor magnus tendon. Thetrochlear surface of the femur belongs to-the epiphysis. A transverse section of the femur aboutthe epiphysial line will show that the outerpart of the bone is much more extensivethan the inner part (Fig. 435), and this,disproportion is continued for some littledistance upwards in the less expanded partof the bone. The medullary canal ceases,some way above the point at which theshaft of the bone widens out to form thecondyloid extremity. Indeed, none of theseoperations concern the canal. The synovial membrane of the knee-joint extends upwards as a large cul-de-sac above the patella andbeneath the extensor tendon. This cul-de-sac is somewhat triangular,has its base at the condyles and its narrowest part uppermost, and. FIG. 434.—VERTICAL SECTIONOF THE LOWER END OF ADEFORMED FEMUR, FROMAN EXTREME CASE OF GENUVALGUM. A, Line of epiphysis ; B, Trans-verse line drawn at level ofadductor tubercle ; c, Lineof Mace wens operation. chap, ij OSTEOTOMY FOR GENU VALGUM 693 reaches a point an inch or more above the upper margin of thetrochlear surface of the femur. When the knee is bent, the cul-de-sac is drawn down. Above the synovial pouch is a bursa, which communicates withthe knee-joint in about seven cases out of ten. In certain of these operations the position of the anastomoticamagna artery must be borne in mind. The following operations will be described : 1. Osteotomy of the shaft of the femur from the outer side. 2. Macewens supracondylar operation. 1. Osteotomy of the Shaft of the Femur from the Outer Side. —The patient lies upon the back, with the knee flexed over the woodenblock or sand-bag, upon which the limb is made to rest securely. Thesurgeon should stand to
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