Surgery; its theory and practice . eration be un-dertaken where the joint is disorganizedby osteo-arthritis, or where the synovialmembrane is studded with masses of car-tilage. Under other circumstances the loose body should be removed. This may be done either by thedirect or the indirect method. The former consists in transfixingthe loose cartilage by a strong needle on a handle thrust throughthe skin, so that the loose body may not slip away or be lost dur-ing the operation, and then cutting down on the capsule, andwhen all bleeding has been stopped, opening the joint. Thebody if loose will
Surgery; its theory and practice . eration be un-dertaken where the joint is disorganizedby osteo-arthritis, or where the synovialmembrane is studded with masses of car-tilage. Under other circumstances the loose body should be removed. This may be done either by thedirect or the indirect method. The former consists in transfixingthe loose cartilage by a strong needle on a handle thrust throughthe skin, so that the loose body may not slip away or be lost dur-ing the operation, and then cutting down on the capsule, andwhen all bleeding has been stopped, opening the joint. Thebody if loose will generally slip through the opening ; if attached,its pedicle must be ligatured and divided. The operation shouldbe performed with the strictest antiseptic precautions, and thepatient prepared by a weeks rest in bed, in the case of the kneewith his joint on a splint. The splint should be continued afterthe operation, or the joint placed in a plaster-of-Paris bandagetill the wound has healed and all fear of inflammation has The formation of a loose car-tilage in a joint. A little massof cartilage attached by aslender stalk. (St. Bartholo-mews Hospital Museum.) 254 DISEASES OF SPECIAL TISSUES. The indirect method consists in incising the capsule subcutane-ously with a tenotomy knife, forcing the loose body through theincision into the connective tissue around the joint, and theneither allowing it to lemain there permanently, or removing itafter the hole in the capsule has healed. The operation is diffi-cult to perform, and since the introduction of antiseptics pos-sesses no advantage over the direct method. Ankylosis or stiff joint may be divided into the fibrous andthe bo7iy. A spurious form of ankylosis, due to the contractionof the surrounding muscles or of cicatrices after burns, may alsooccur, but is generally associated with some amount of fibrousankylosis. Fibrous ankylosis, also called ligamentous, or by some authors,false, in contradistinction to the bonywhich t
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectsurgery, bookyear1896
