Surgery, with Special Reference to Podiatry — John Shaqi
Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Treatment.+ Rest and wet dressings generally suffice to effect
restitution in a few weeks.
+Penetrating.+ Should the joint be injured by violence so that there is
a loss of continuity of the tissues leading into the joint proper,
there is every probability of infective material gaining entrance.
These are serious accidents, though restoration of an efficient joint
is possible, but when improperly treated or neglected, local
destruction, or even loss of life may occur.
Penetrating wounds of joints usually occur in consequence of accidents
with firearms, sharp tools, or falling upon sharp objects. Frequently,
penetration of a joint follows suppuration in the immediate
neighborhood.
+Symptoms.+ The extent of the injury, the particular joint involved, and
the nature of the vulnerating body will affect the train of symptoms.
An escape of synovial fluid, pain and some swelling will occur even
with a very small penetration. Should the joint escape infection, the
synovitis quickly subsides and recovery takes place with little or no
impairment of the functional value of the part. The opening in the
capsule closes, the extravasated blood is absorbed and the synovial
surface is again smooth. If, however, the wound has been inflicted
with an unclean instrument, or if at any time before healing it
becomes septic, a very different and graver condition obtains.
+Septic Arthritis.+ Infection with bacteria of suppuration, chiefly the
staphylococcus albus or the streptococcus pyogenes, produces an acute
arthritis which frequently, despite the most careful treatment, will
result in the destruction of the joint, and not seldom in the loss of
life.
The infection may occur in one of several ways: (1) directly through a
dirty instrument, or the lodgment of infective material in the tract
leading to the joint cavity; (2) by the extension of a suppurative
process, either of the bones or soft tissue adjacent; or, by (3) the
deposition into the joint of infective organisms circulating in the
blood stream.
+Symptoms.+ However produced, large numbers of organisms are present and
a high grade of inflammation ensues. An abundant amount of pus is soon
formed; the synovial membrane, the bone ends and the joint capsule are
actively inflamed, and soon become disorganized. Perforation of the
capsule is followed by infection and suppuration of the tendons and
other structures about the joint, which soon affects the superficial
structures and forms an opening through the skin. The pain is intense,
generally worse at night; the swelling is great and fluctuation is
distinct; the skin is red and hot, and the parts above and below are
edematous. Any attempt at motion increases the suffering.
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