British medical journal . elbow this will dependlargely upon occupation, and to a lesser extent also in thecase of the hip. The hip is usually best fixed fully ex-tended, as is also tlie knee; if bony ankylosis should occur alittle flexion at both joints is no disa<lvantage. The ankleshould be fixed at right angles, and the elbow slightly below the rightangle. The wristshould be kepthyperextended. I need say noinoi-e in regardto preventivemeasures. Whenv,e reaUze th edeformity of theuntreated case w-ccan always beprepared for itsprevention. To simplify thesubject take lir<ttuberculous de
British medical journal . elbow this will dependlargely upon occupation, and to a lesser extent also in thecase of the hip. The hip is usually best fixed fully ex-tended, as is also tlie knee; if bony ankylosis should occur alittle flexion at both joints is no disa<lvantage. The ankleshould be fixed at right angles, and the elbow slightly below the rightangle. The wristshould be kepthyperextended. I need say noinoi-e in regardto preventivemeasures. Whenv,e reaUze th edeformity of theuntreated case w-ccan always beprepared for itsprevention. To simplify thesubject take lir<ttuberculous de-formities in tlieyoung. At theoutset it may beasked, At whatstage of thedisease shouldw e correct d e-formity? Shouldwe alter the mal-position of a jointin the stage of its activity, or wait until recovery hastaken place? It is perfectly safe to correct deformityflnring the active period, and comparatively simple. Myexperience does not favour the view that by this acta general dissemination of tubercle -^^-ill bo caused,. Fig. 1.—Abfluction frame applied forright tuberculous liip. In tle h. >-joiut, therefi ce, when a case presents flexion,adduction f,ud elevation o£ the pelvis, I apply a frame soconstructed as to govern the triple deformity (Fig. 1). Thasplint should never bo fitted to the deformity, but thodeformity should bo moulded to tho splint. The limb isthen retained rigidly at rest both to recover from themanipulation and in obedience to the princii)!cs accordingto which we treat such joints. It is obvious that thomanipnlatiou should be practised without excessive force,slowly and gently, never rapidly or roughly. In the case of the knee, flexion and tibial displace-ment are corrected together, and the limb placed ina Thomass bed knee splint. Tiie correction is notnecessarily completed at the one sitting. The deformitymay be only partially reduced and then the treatmentbe completed by extension in the s))lint. Palmar flexion at the wrist should be changed to dor
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Keywords: ., bookcentury1800, bookdecade1850, booksubjectmedicine, bookyear185
