OCR Text |
Show .« A."-‘" w-A--<..‘,-s-.~u .- 108 When the large bursa under the deltoid muscle, and the acromion process of the shoulder is enlarged and full of fluid, compression and stimulants failing, it may be opened it it have arisen as a remote consequence of a bruise. No tumours arising from the deep parts of the hip joint should be opened ; even the lesser tumours about the ancle joint and wrist ought not to be touched with the knife or lancet" The LOOSE CARTILAGES or movcablc bodies which form within the knce joint are with dilliculty to be accounted for. They are, however, a cause of great distress and lameness. (ihisut it... i j. LOOSE CARTILAGES IN THE KNEE room. Loose CARIILAGES I)? run 1;an 10m 1'. A fine young man shall be at cricket, in full career, when these bodies escaping from the corners in which they usually lie, and coming betwixt the heads of the bones, he will be thrown down with a pain in the knee, extrcmeiy violent and at the same time sickening and subduing. Assisted by the experience of the patient, we are to endeavour to get the body from be- t. raw-{'76:- -..il‘fi‘- _-....~ .. I . -~»»x>.~,r~rr_-'rt' :. "fir-3V?" ‘4‘ c.17-c ..k .. t: twixt. the prt'miincnt parts of the bones ; if the body remains long in a situation giving pain, the secretion of the joint is in‘ creased, and a considerable inflammation will rise. In this state we must allow the loose body to rest where it.is, and keep the patient from exercise until it shall, by some accident of position, drop into the place of rest. When we have got the body extricated from betwixt the bones, we must endeavour to keep it there by binding the joint, and pressing down the patella, that no exudation may be poured out in any quantity, and that the surfaces of the bones may be kept in contact, so that the body cannot insinuate itself betwixt them. I have said that I am averse from opening the knee joint, and I have never seen a case of loose bodies in the joint", where I could recommend it, or where the pain, lameness, and confinement, attending the presence of the body, were not outweighed by the danger which the operation presented. If ever the temptation to operate should present itself to me it must be in this form: the patient shall have been long 109 risk to the incessant pain and helplessness, and the body with« in the knee must be loose, and distinctly felt prominent. The OPERATION may be thus conducted: The body hav- . ing presented in the side of the joint, and upon trial is found to be so far stationary that, it bears pressure, and the motion of the skin over it, the assistant is to be employed thus: He must, with the fingers of one hand, draw aside the in- teguments which naturally lie over the body to be cut out, and hold them firmly ; with the finger of the other hand he must thrust upon the integuments by the side of the body, and into the interstice of the margins of the bones, so that he may prevent the body from moving on that sidede The surgeon (having his instrument ready to be handed to him) fixes the finger of his left hand on the other side of the body to be out upon ; then with a very sharp scalpel he cuts lightly on the skin until the body starts out or is exposed. As soon as it is exposed the hook is to be introduced behind it, that it may be brought forward. If forceps of a common form he used the body is apt to start from them; they should be armed with sharp crooked claws at the point. If the loose body escape, the probability is that we shall not be able to bring it to the same spot again, and the danger of the operation will have been incurred without advantage. If the body adhere to the ligaments by a neck, it can be cut away easily, but if it have a broad connexion and require the first incision to be enlarged and a dissection made, it is very unfortunate. By all means let the wound be closed as quickly as possible. I cannot refrain from expressing my wonder that any one should recommend the incision to be left open for the discharge of the fluid of the joint. The patient must be kept long perfectly quiet, and the wound must be entirely healed before he be allowed to use his leg. * Some have recommended that the loose body should be moved up words on the side of the condylc, towards the connexion of the capsule with tormented, the occasional lameness and confinement must in- the thigh bone. terfere with his means of living, he must himself prefer th!‘ middle oftlie capsule. Iftliis can be dew, it is certainly better than cutting in the But the general rule is to take that position in with 1‘. ‘tie body stands most prominent and secure, |