A manual of operative surgery . described,and a division of the tibia just below itstuberosities (page 700). We have operated on a fair number ofthese cases, which present a most difficultproblem to the surgeon. We have obtainedthe best results from a true excision ofthe ankylosed joint. This does not leavean awkward angle, as the previously de-scribed methods do. The incision of thewedge is illustrated in Fig. 430, and theoperation is described on page 686. In these cases of extreme deformitygreat care must be taken in extending the limb after the operation. The tissues of the popliteal regio
A manual of operative surgery . described,and a division of the tibia just below itstuberosities (page 700). We have operated on a fair number ofthese cases, which present a most difficultproblem to the surgeon. We have obtainedthe best results from a true excision ofthe ankylosed joint. This does not leavean awkward angle, as the previously de-scribed methods do. The incision of thewedge is illustrated in Fig. 430, and theoperation is described on page 686. In these cases of extreme deformitygreat care must be taken in extending the limb after the operation. The tissues of the popliteal region willbe much contracted, and a gradual straightening of the limb,extending over a week or more, and associated possibly with thedivision of certain tendons and bands of fascia, will be general terms, it may be said that the limb may be extended withsafety so long as the tibial arteries pulsate freely at the ankle. As soon as the wound is soundly healed and the limb straight,a plaster of Paris case may be FIG. 438.—BONY ANKYLOSISOF KNEE AT A RIGHT--ANGLE IN A GIRL OF12, AFTER TUBERCULOUS-DISEASE. Osteotomy of the Tibia Under this title three operations will be described : 1. Linear osteotomy just below the tuberosities. 2. Linear osteotomy for bent tibia. 3. Cuneiform osteotomy for bent tibia. 700 OPERATIONS ON BONES AND JOINTS [part vii i. Linear Osteotomy of the Tibia just below the Tuberosities. —This operation is carried out in the treatment of exceptional cases•of faulty ankylosis of the knee-joint, as mentioned previouschapter. Operation.—The leg is firmly fixed upon the block or sand-pillow,with the anterior surface well exposed. In every case the surgeonstands to the outer side of the limb to be dealt with. A spot is selected just below the tubercle of the tibia, and a trans-verse incision of the necessary width is made over the anterior tibial !
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