American practice of surgery : a complete system of the science and art of surgery . r. When the surgeon has decided that disease existsin the neighborhood of one or more of the epiphyses, he should lose no timewhatever in making the necessary incisions down to the seat of inflammation. INFLAMMATORY AFFECTIONS OF BONE. 293 He should not be content with finding evidence of disease at one epiphysis with-out also making himself equally certain of its absence at all others. Moreover,an unnecessary incision is less to be deplored than the neglecting of a neededone. The incisions made should be as f
American practice of surgery : a complete system of the science and art of surgery . r. When the surgeon has decided that disease existsin the neighborhood of one or more of the epiphyses, he should lose no timewhatever in making the necessary incisions down to the seat of inflammation. INFLAMMATORY AFFECTIONS OF BONE. 293 He should not be content with finding evidence of disease at one epiphysis with-out also making himself equally certain of its absence at all others. Moreover,an unnecessary incision is less to be deplored than the neglecting of a neededone. The incisions made should be as free and as numerous as the case re-quires, but indiscriminate slashes of unnecessary length and in haphazard posi-tions are much to be deprecated. The greatest care also should be taken torespect the anatomical features of the locality in making the cuts. Itis quite true that some of the epiphyses may be reached with absolutely nodanger to important structures, but, on the other hand, there are many placeswhere incisions may be required in which anatomical skill and knowledge are. Fig. 141.—Acute Osteomyelitis Affecting Both Extremities of the Shaft of the Tibia. Sequestrawere removed from the cloacae a and c, but the main portion of the shaft survived, b Shows thick-ening of the bone due to osteoplastic periostitis. (Original.) indispensable requisites in the individual undertaking such surgical example, the external popliteal nerve in the leg and the ulnar nerve in thearm are each so placed as to render it necessary that they should be carefullyavoided during operations for disease in these regions, and in nearly every oneof the epiphyses of the long bones the careless surgeon might open a joint cavitywith results likely to be extremely disastrous. When the question of opera-tion on individual epiphyses comes to be considered, the necessary instructionsas to how injury to important structures may be avoided will be pointed outmore fully. After having so strenu
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