. Modern surgery, general and operative. e limb,over the middle of the space between the frag-ments, from well above the upper fragments to wellbelow the lower piece. The soft parts are retracted,but the periosteum is undisturbed; each fragmentis bored (Fig. 491, i) in one or two places; the sur-faces of the fragments are sawed straight across,through sound bone; all old reparative material is cutaway; the wires are passed through the perforations,twisted, cut off, and hammered down (Fig. 491, 2).If the bone-fragments cannot be approximated, itmay become necessary to incise the muscle aroundan
. Modern surgery, general and operative. e limb,over the middle of the space between the frag-ments, from well above the upper fragments to wellbelow the lower piece. The soft parts are retracted,but the periosteum is undisturbed; each fragmentis bored (Fig. 491, i) in one or two places; the sur-faces of the fragments are sawed straight across,through sound bone; all old reparative material is cutaway; the wires are passed through the perforations,twisted, cut off, and hammered down (Fig. 491, 2).If the bone-fragments cannot be approximated, itmay become necessary to incise the muscle aroundand above the patella or partially to separate thetuberosity of the tibia and bend this process up-ward. A small drain is inserted above the bone,the wound is sutured, aseptic dressings are applied, and the limb is put upona Macewen splint. Trevess Operation for Caries of the Lumbar and Last Dorsal Ver=tebrae, with Abscess in the Psoas Magnus or Quadratus LumborumMuscle.—The patient lies upon his left side, with the knees drawn up and a. Fig. 491.—Wiring of thepatella: i. Fragments cut andcleaned and the wires passed;2, wires twisted and hammereddown upon the bone (afterBarker). Aspiration of Joints 785 sand-bag under the left loin. The surgeon stands behind the patient (Barker).An incision is made at the outer border of the erector spinae mass, reaching fromthe last rib to the iliac crest and going down at once to the lumbar fascia. Thelumbar aponeurosis is opened, the erector s[)ina muscle is retracted inward, andthe anterior portion of the erector spinae sheath is incised. The quadratus lum-borum muscle is next cut, and then the anterior leaflet of the lumbar aponeu-rosis is slit. The abscess is thus reached and opened and tuberculous pusflows out. The abscess-cavity is irrigated with ciuantities of warm corrosivesublimate solution (i : 5000). The cavity is tilled, the fluid is allowed to flowout, its exit being aided by pressure in front and changes of posture; the cavity
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Keywords: ., bookcentury1900, bookdecade1910, bookidmodernsurger, bookyear1919
