A treatise on orthopedic surgery . has fol-lowed infectious arthritis of a mildform, or monarticular rheuma-tism, forcible manipulation maybe attempted. If under gentlemanipulation the adhesions giveway suddenly, permitting free mo-tion, the progTiosis is good; but ifthere is a peculiar, elastic, con-tinuous resistance, as when there areextensive adhesions within the joint,there is little likelihood of attainingmotion by this means. If but slightforce has been exerted there is usu-ally but little reaction, and massageand passive motion may be em-ployed at once; but in other in-stances the mani
A treatise on orthopedic surgery . has fol-lowed infectious arthritis of a mildform, or monarticular rheuma-tism, forcible manipulation maybe attempted. If under gentlemanipulation the adhesions giveway suddenly, permitting free mo-tion, the progTiosis is good; but ifthere is a peculiar, elastic, con-tinuous resistance, as when there areextensive adhesions within the joint,there is little likelihood of attainingmotion by this means. If but slightforce has been exerted there is usu-ally but little reaction, and massageand passive motion may be em-ployed at once; but in other in-stances the manipulation is followedby swelling and pain, and untilthese symptoms have subsided fixa-tion may be indicated. It may bementioned that anchylosis follow-ing disease is usually accompaniedby marked atrophy of the bones, and fracture may occur duringforcible correction. In cases of this character the complicationof fat embolism is sometimes encountered. If the deformity isof long standing complete correction should not be attempted at. Anchylosis at the hip, showingmasses of new bone. (From theMuseum of the College of Physi-cians and Surgeons.) 302 OETHOPEDIC SUBGEBY. one sitting. At the knee for example the hamstring tendons maybe divided and the deformity having been partly corrected aj)laster bandage should be applied. After an interval of a weekor more further correction is attempted by reverse leverage as described elsewhere. If the resistance can not be readilyovercome a subcutaneous osteotome is inserted just above thejoint and the correction is made complete by fracturing thefemur. In cases of bony anchylosis in youthful patients evenright angular deformity should be corrected by osteotomy ratherthan by removal of a wedge of bone which must include theepiphyseal cartilages. After subsidence of the reaction that usually follows forciblecorrection, passive movements within the range that is practi-cally painless may be carried out manually, or by means of oneof the so-called p
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