. Text-book of operative surgery . the bones,the lateral ligaments, afterchiselling through the epi-condyles, are more exten-sively separated from thebones. In the case of thefemur it is especially im-portant, after sei^aration ofthe periosteum and capsule Fig. 160.—Arthrotomy of the kuee by an external curved incisiou, giviug a complete exposure of theJoint. The capsule has been split upwards into the lower muscular fibres of the vastusexternus, and dovvnwards as far as the tnbercle of the tibia, which has been chiselled off, stillretaining its connection with the periosteum below, which is s
. Text-book of operative surgery . the bones,the lateral ligaments, afterchiselling through the epi-condyles, are more exten-sively separated from thebones. In the case of thefemur it is especially im-portant, after sei^aration ofthe periosteum and capsule Fig. 160.—Arthrotomy of the kuee by an external curved incisiou, giviug a complete exposure of theJoint. The capsule has been split upwards into the lower muscular fibres of the vastusexternus, and dovvnwards as far as the tnbercle of the tibia, which has been chiselled off, stillretaining its connection with the periosteum below, which is separated for a short whole of the lower part of the quadriceps apparatus can now be everted and thrown overto the inner side. The anterior attachments of the semilunar cartilages are detached andreflected, the one inwards and the other outwards, each retaining its connection with the capsule. ARTHROTOMY, OSTEOTOMY, AND RESECTION 297 as far as the epicondyles, to detach these bony processes, together with the lateral. Fig. 161.—Excision of knee. Tubercle of tibia and seraihinar cartilages detached as in Fig. 160 ; theattachments of the lateral ligaments are chiselled off through the epicondyles of the femur,and the crucial ligaments are separated from the intercondyloid notch of the femnr and theUpper snrface of the tibia in continnity with the capsule. ligaments and tendon-insertions, with hammer and chisel (according to the plan intro-duced by König for preserving the attachments of the ligaments), and to displace 298 OPERATIVE SURGERY them backwards, in continuity with tlie periosteum, as far as the level of tlie sawline (Fig. 161). In Order to further firm ankylosis by accurate apposition of tbe bones, tbe way inwhicli tlie ends of the bones are sawn off is a most important matter. To avoidforward displacement of tbe femur upon the tibia, the saw has been directed at allkinds of angles, and a great variety of means of fixing the sawn surfaces has beenemploy
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