. Manual of operative surgery. maining portion oftrochanter (b) must be removed flush withthe femoral neck by means of the chisel orbone forceps. Step 4.—With retractors expose thefemoral neck. Choose the point at whichthe neck is to be divided. With a peri-osteal elevator bare the bone of the neckat the line of section. Divide the this purpose use a finger saw, orbetter, the Gigli wire saw. Step 5.—Removal of the femoral writes as follows: The removalof the head is often difficult. Sometimesit has sunk into the cotyloid cavity whichhas been widened by disease and whoseineq
. Manual of operative surgery. maining portion oftrochanter (b) must be removed flush withthe femoral neck by means of the chisel orbone forceps. Step 4.—With retractors expose thefemoral neck. Choose the point at whichthe neck is to be divided. With a peri-osteal elevator bare the bone of the neckat the line of section. Divide the this purpose use a finger saw, orbetter, the Gigli wire saw. Step 5.—Removal of the femoral writes as follows: The removalof the head is often difficult. Sometimesit has sunk into the cotyloid cavity whichhas been widened by disease and whoseinequalities of surface have hooked them-selves on to similar inequalities of thefemoral head; sometimes it is so changed in form that it has become firmlyfixed in an excavation of the acetabulum; occasionally its surface is partially orentirely united to the bone of the acetabulum. In other cases, especiallywhen acute osteomyeHtis has been present, the epiphysis is separated and thehead itself is anchvlosed to the Fig. 1203.—Konigs arthrectomy. Fig. 1204.—Konigs lever. iMi t^SI In simple cases when room is made by pulling the limb downwards onecan remove the head with a periosteal elevator. In difficult cases a speciallystrong, spoon-faced lever is required. (The author has had one made ofthe following dimensions, i4X%X/^ inches (Fig. 1204). It reminds oneof a burglars jimmy, but is thoroughly efficient.) EXCISION HIP 985 In unusally difficult cases one may chisel away a portion of the posteriorsuperior rim of the acetabulum (a, Fig. 1203). This would be done in anyevent after the removal of the head. Examine the trochanter and the remnant of the neck. If disease is presentin these structures attack it with chisel and sharp spoon. Step 6.—Examine the cotyloid cavity both by touch and sight. Removesufficient of the posterior superior cotyloid rim to permit of free inspection ofthe cavity. If disease exists in the pelvic bones remove it thoroughly withchisel a
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