. Manual of operative surgery. and mallet dividethe head of the femur where it is fused to the pelvis. Preserve as much aspossible of the head of the bone attached to the neck. When the bone isdivided, clean out the cotyloid cavity with gouge and rongeurs so as to makeit concave and smooth. Smooth and round off the remnant of the head ofthe femur. If the trochanter and neck of the femur are very much deformedand are so anchylosed to the ilium that it is impossible to reform the head andneck of the bone, divide the fused mass; cut a cavity in the iliac bone; seethat this cavity is provided with
. Manual of operative surgery. and mallet dividethe head of the femur where it is fused to the pelvis. Preserve as much aspossible of the head of the bone attached to the neck. When the bone isdivided, clean out the cotyloid cavity with gouge and rongeurs so as to makeit concave and smooth. Smooth and round off the remnant of the head ofthe femur. If the trochanter and neck of the femur are very much deformedand are so anchylosed to the ilium that it is impossible to reform the head andneck of the bone, divide the fused mass; cut a cavity in the iliac bone; seethat this cavity is provided with a prominent superior and posterior border;round off the top of the upper end of the femur so that it may fit into theabove-mentioned cavity. Step 3.—The new articulating surfaces having been prepared, interpose alayer of muscle between them as follows: Divide the rectus femoris muscleabout 4 inches below its origin, mobilize it, let it fall into the new-formedcotyloid cavity and fix it there with a few sutures (Fig. 1214).. Fig. 1213. 992 ANCHYLOSIS HIP Step 4.—Place the femur in position. Close the wound with or withoutdrainage. Apply dressings and extension. Keep immobilized until thewound has healed and then gradually begin exercises. Rochet has shown that by operating from the front the glutei muscles andthe strong upper and posterior parts of the capsule are preserved intact. Thesestructures prevent the femur from riding up over the ilium. In some caseswhere there is much inversion of the thigh, the anterior operation is impossibleand it becomes necessary to adopt Langenbecks or OUiers incision for excision — d Fig. 1214.—Nelatons arthroplasty. (Huguier.)a. Flap of rectus muscle; 6, ilio. femoral band; c, tensor fasciae latae; d, sartorius; e, neck of femur. of the hip. The operation so far as exposing the joint is concerned is the sameas in excision and requires no special notice at this place. The bones are dividedand treated as in Nelatons operation, but the mu
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