A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
EXCISION OF THE HIP-JOINT.--The question as to the propriety of
performing this operation in any case is still debated by some surgeons,
and the selection of suitable cases for the operation is greatly
modified by the varying opinions of the different schools of surgery.
Enough here to describe the method of operating, and the amount of the
bone which is to be removed.
As in the shoulder-joint, the head of the femur is much more liable to
disease, and, as a rule, much earlier attacked than is the acetabulum,
but unfortunately the acetabulum does eventually become affected also in
probably a much larger proportionate number of cases than the glenoid.
Caries of the head, neck, and trochanters of the femur is a very common
disease in this variable climate, and frequently connected with the
strumous taint. After much suffering, abscesses form and discharge,
giving considerable pain, and often end by carrying off the patient. As
a result of the abscess and destruction of the ligaments, the head of
the bone is apt to be displaced, and under some sudden muscular exertion
or involuntary spasm, consecutive dislocation of the femur (generally on
to the dorsum ilii) very often occurs.
In such a case the operation of excision of the head of the femur is by
no means difficult, and not excessively dangerous, especially in young
children.
_Operation._--It is hardly necessary, or indeed possible, to lay down
exact rules for the performance of this operation, in so far as the
external incisions are concerned, for the sinuses which exist ought in
general to be made use of.
When the surgeon has his choice, a straight incision (Plate II. fig.
A.), parallel with the bone, extending from the top of the great
trochanter downwards for about two inches, and also from the same point
in a curved direction with the concavity forwards, upwards towards the
position of the head of the bone (see diagram), will be found most
convenient. The incisions should be carried boldly down to the bone,
which will often be felt exposed and bathed in pus, any remains of the
ligamentous structures must be cautiously divided with a probe-pointed
bistoury, and then by bringing the knee of the affected side forcibly
across the opposite thigh, with the toes everted, the head of the bone
is forced out of the wound. The head, neck, and great trochanter should
be fully exposed, and the saw applied transversely below the level of
the trochanter, so as to remove it entire. If this is not done, it
prevents discharge, protrudes at the wound, and besides this it is
almost invariably diseased along with the head. Chain saws are quite
unnecessary, it being in most cases easy to apply an ordinary one to the
bone, if it is properly everted.
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