. Operative surgery. equent correctionof the deformity. The fibula, owing to its mobile association with the tibia,does not require division at this situation. It is often necessary, however, tocut the hamstring tendons before the deformity can be properly corrected. The Operation hy Cuneiform Osteotomy.—Although this variety of oste-otomy may be applied to deflected curves, the linear is much the better, andthe cuneiform method should be rather employed in instances of anchylosisof the knee with marked flexion of the leg. It can be employed above(Barton) or through the joint. The latter is mu
. Operative surgery. equent correctionof the deformity. The fibula, owing to its mobile association with the tibia,does not require division at this situation. It is often necessary, however, tocut the hamstring tendons before the deformity can be properly corrected. The Operation hy Cuneiform Osteotomy.—Although this variety of oste-otomy may be applied to deflected curves, the linear is much the better, andthe cuneiform method should be rather employed in instances of anchylosisof the knee with marked flexion of the leg. It can be employed above(Barton) or through the joint. The latter is much the better plan. Thesize of the piece to be removed can readily be estimated by noting thecourse of two imaginary lines dropped perpendicularly to the long axes ofthe tibia and femur respectively (Fig. 459). If these lines be so dropped asto join at the angle of the deformity, they will indicate the minimum amountof bone that should be removed. A still greater saving of bone can be made30 44:2 OPERATIVE Fig. 459.—Cuneiform incision for bony anchylosis ofknee joint. if the cuneiform section ceases at the posterior third of the transversediameter, which part is then overcome by fracture as the limb is straight-ened. In all instances the lines of division of the two bones must be madeso as to be parallel with each other when the leg is brought into the cor-rect position, otherwise anew deformity will be cre-ated—deflection of the the degree of flexion be aminor one, linear osteotomywill suffice for the rectifica-tion. The General BemarTcs.—Care must be observed thatthe osteotome does not in-vade the popliteal space asthe vessels and nerves maybe directly injured thereby,or from the resulting sharpfragments of bone. In the case of fibrous anchylosis the use of the weightand pulley should be employed to overcome as much as possible the de-formity, and also to stretch to the fullest extent the opposing soft partsbefore osteotomy is done. In no instance, ei
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