. Text-book of operative surgery . Fig. 291.—Skiagram of stump, oue aud a halfyears after osteoplastic amputation. for stumps formed by the sub-periosteal method. ^ The first communication, B. Gliir. Bd. 34. •^ D. med. Wochenschr., 1899, No. 47. Ar eh. f. Ortho2Jädie, Bd. 3. AAIPUTATIONS AND DISARTICULATIONS iöl In Opposition to Biers views, Hirsch and Bunge ^ have correctly sliown tliat theprotection of the raw encl of the hone from pressure is of far less importance than theremoval of all sensitive structures at the Operation; especially the periosteum and,according to Bunge, also
. Text-book of operative surgery . Fig. 291.—Skiagram of stump, oue aud a halfyears after osteoplastic amputation. for stumps formed by the sub-periosteal method. ^ The first communication, B. Gliir. Bd. 34. •^ D. med. Wochenschr., 1899, No. 47. Ar eh. f. Ortho2Jädie, Bd. 3. AAIPUTATIONS AND DISARTICULATIONS iöl In Opposition to Biers views, Hirsch and Bunge ^ have correctly sliown tliat theprotection of the raw encl of the hone from pressure is of far less importance than theremoval of all sensitive structures at the Operation; especially the periosteum and,according to Bunge, also the marrow. This view culminated in the introduction ofthe aperiosteal naethod of amputation. In the latter method it has been conclusively proved by Bunge, v. Eiseisberg(Ranzi), Moskowicz, Amberger, Manninger, and Steiger -^ (of our clinic), that the. FlG, 202.—Skiagrani of stump tliree auel a half inouüis after aperiosteal iu regard to beariiig pressure. Very good cicatricial sawn end of the bone is not in itself tender, even though the medullarycavity has been left open. Tenderness is due much more to excessive growth of the periosteum (perhaps alsoin the marrow, Bunge) which leads ultimately to the production of exostoses, and canmost easily be prevented by a complete removal of the periosteum covering the endof the stump, although the experience of Hirsch and ourselves also shows thatexostoses can be prevented by accustoming the limb early to bearing weight on itssurface. Verhandlimgen d. deutsch. Chirurgie, 1900, ff. 22 ^ Bern Dissertation, lß03. 338 OPERATIVE SURGERY We here reproduce some characteristic radiographs wliich liave been publisliedby Steiger in our clinic. Fig. 201 represents the appearance after an osteoplasticamputation of the leg (Bier and Eiselsberg method), in a man aged fo
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