A treatise on orthopaedic surgery

Front matter

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Book L

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Preface

The student of Orthopaedic Surgery is especially concerned with the mechanics of the human machine, with its development, with its capacity at different periods of life and under varying conditions, and with those affections that lead to deformity or that otherwise impair its usefulness. He is concerned, moreover, not only with the local and immediate effects of disease or disability, but also with its general influence upon the entire mechanism, and with its ultimate consequences as well.

Orthopaedic Surgery occupies a broad field and one of very great and general interest. Its most distinctive advance in recent years has been toward the prevention of deformity, an advance that has been made possible by the better understanding of its predisposing and exciting causes. As a natural consequence, treatment has become more direct, more simple, and more effective. It has been the purpose of the author to emphasize this aspect of the subject, which is of the greatest importance to the general practitioner, who so often has the opportunity to recognize disease or disability in its incipiency, when its progress may be checked by timely treatment.

He has endeavored to present Orthopaedic Surgery as far as possible objectively, a method which has proved acceptable t6 students and practitioners in clinical teaching ; thus the selection of each subject and the space that has been allotted to it has been determined primarily by its relative importance in the actual work of Orthopaedic clinics. He has been at some pains, also, to outline methods of examination, to explain the phenomena of the symptoms and so to describe and to illustrate the causes and effects of disease and disability as to indicate, in natural sequence, the principles of treatment. The particular methods of the application of those principles, which have always been described in detail, are those that have been tested by personal experience.

Although this book is designed particularly for students and practitioners of medicine, the author has included statistical and other data vi PREFACE.

which he hopes may prove of interest to his fellow-workers in this special field.

The author desires to express his obligation to the gentlemen who have assisted him in the collection of statistics, and otherwise, whose names are mentioned in the text ; to Dr. L. W. Ely and to Mr. W. P. Agnew for timely photographs, and especially to the Trustees of the Hospital for Ruptured and Crippled, for the facilities that have been afforded him in the preparation of this work. R. W.

New York, 1901.

Chapter I. Tuberculous Disease Of The Spine

Description — Pathology — Etiology — Statistics — General prognosis — Symptoms — Physical examination — Contour and flexibility of the spine — Divisions of the spine — Landmarks — The differential diagnosis of disease in the lower, middle and upper regions of the spine — Treatment by horizontal fixation — by braces — by jackets — by other means. The selection and adaptation of treatment for disease of the different regions of the spine. The complications of tuberculous disease of the spine — Abscess — course — symptoms — treatment. Paralysis — course — symptoms — treatment. Forcible correction of deformity — (Calot's operation) — Gradual correction of deformity. ... 17

Chapter II. Non-tuberculous Affections Of The Spine

Syphilis — Malignant disease — Osteomyelitis — Actinomycosis — Injury — Traumatic spondylitis — Rhachitic spine — Typhoid spine — Gonorrhceal "rheumatism'* of the spine — Arthritis — Spondylitis deformans — Osteitis deformans — Neurotic spine —Hysterical spine — Spondylolisthesis — Sciatic scoliosis — Sacro-iliac disease 107

Chapter III. Lateral Curvature Of The Spine

Description — habitual and fixed deformity, rotation and lateral deviation. Pathology — Etiology — Statistics — Varieties — Distribution and effects of deformity —Symptoms — Diagnosis — Prognosis — Prevention of deformity — Treatment — by exercises — general exercises — heavy exercises — special exercises — Supports. Forcible correction of deformity — Adjuncts in treatment — Duration of treatment. 120

Chapter IV

DEFORMITIES OF THE SPINE, CONTINUED. DEFORMITIES OF THE CHEST. FUNCTIONAL PATHOGENESIS OF DEFORMITY.

Varieties in contour of the spine — Kyphosis — Lordosis — Congenital elevation of the scapula — Absence of vertebrae — Flat chest — Pigeon vm CONTENTS.

chest — Funnel chest — Absence of ribs — Defective formation of the pectoral muscles — Absence or defect of the clavicle — Acquired luxation or subluxation of the clavicle — Asymmetrical development — Tables of height, weight, and circumference of the chest — Functional pathogenesis of deformity — (Wolff's law) 181

Chapter V. Tuberculous Disease Of The Bones And Joints

Predisposition — Mode of infection — Latent tuberculosis — Local predisposition — Statistics — distribution of disease — location — side affected — sex — age. Pathology — Varieties of disease — Method of repair — Prognosis — Treatment — operative and mechanical — by drugs — local applications — venous stasis (Bier's treatment) 194

Chapter VI. Non-tuberculous Diseases Of The Joints

Syphilitic disease of joints — Gonorrhceal arthritis — Other forms of infectious arthritis — Acute epiphysitis — Localized infectious osteomyelitis — Osteo- arthritis — Haemophilia — Hsemarthrosis — Scorbutus — Charcot's disease — Anchylosis 206

Chapter VII. Tuberculous Disease Of The Hip Joint

Pathology — Statistics — Symptoms — Physical signs, distortion, apparent lengthening, apparent shortening. Causes of distortion — Atrophy — Causes of actual shortening — Measurements — Lovett' stable— Kingsley's table — Differential diagnosis — Principles of treatment — The traction hip brace — The Thomas brace — The plaster bandage — Various methods of reducing deformity — The long hip splint — Other forms of apparatus — Double hip disease — Abscess — statistics — treatment — Operative treatment — exploration — excision — reduction of resistant deformity — Prognosis, mortality, functional results. Secondary deformities of hip disease — Final results 221

Chapter VIII. Non-tuberculous Affections Of The Hip Joint

Traumatisms at the hip — Acute infectious arthritis — Extra-articular disease — Malignant disease at the hip joint — Cysts of the femur — Arthritis deformans 300

Chapter IX. Tuberculous Disease Of The Knee Joint

Pathology — Etiology — Statistics — Symptoms, primary and secondary distortions — Diagnosis — Differential diagnosis — Treatment — mechan-

CONTENTS. ix

ical — Extra-articular disease — Abscess — Operative treatment — arthrectomy — excision, amputation — Prognosis — mortality — functional results — General conclusions 304

Chapter X. Non-tuberculous Affections Of The Knee Joint

Injury in childhood — Synovitis — Infectious arthritis — Osteo-arthritis — Prepatellar bursitis — Pretibial bursitis — Bursse and cysts in the popliteal region — Internal derangement of the knee joint — Congenital genu recurvatum — rudimentary or absent patella — Congenital displacement of patella — Slipping patella — Elongation of the ligamentum patellae — Snapping knee — Congenital contraction at the knee — General contractions — Acquired genu recurvatum 324

CHAPTER XL

DISEASES AND INJURIES OF THE ANKLE JOINT.

Tuberculous disease — Pathology — Etiology — Statistics — Symptoms— Diagnosis — Treatment — Prognosis — Tuberculous disease of the tarsus — Statistics — Treatment — Sprain of the ankle — Teno-synovitis — Other affections of the ankle joint 334

Chapter XII. Diseases And Injuries Of The Articulations Of The Upper Extremity

Tuberculous disease of the shoulder joint — Pathology — Statistics — Symptoms — Treatment — Prognosis — Tuberculous disease of the elbow joint — Pathology — Statistics — Symptoms — Treatment — Prognosis—Tuberculous disease of the wrist joint — Symptoms — Treatment — Prognosis — Spina ventosa — Periarthritis of the shoulder joint — Chronic bursitis at the shoulder — Sprain of the wrist — Acute teno-synovitis at the wrist 348

Chapter XIII. Congenital And Acquired Affections Leading To General Distortions

Rhachitis — Etiology — Pathology — Symptoms, deformities — Prognosis — Treatment — "Late rickets" — "Fcetal rhachitis" — Infantile scorbutus — Fragilitas ossium — Osteomalacia — Osteitis deformans — Secondary hypertrophic osteo-arthropathy — Acromegalia 361

CHAPTER XIY.

CONGENITAL DISLOCATION OF THE HIP AND COXA VARA.

Congenital dislocation of the hip joint — Statistics — Pathology — Etiology — Symptoms — Diagnosis — Differential diagnosis — Treatment — the x CONTENTS.

open operation — the Lorenz operation — the intermediate operation — secondary osteotomy — Palliative treatment — Coxa vara — Pathology — Etiology — Statistics — Symptoms — Diagnosis — Treatment — mechanical — operative. Fracture of the neck of the femur — Traumatic separation of the epiphysis of the head of the femur 373

Chapter XV. Deformities Of The Bones Of The Lower Extremity

Bow leg — Knock knee — Statistics — Etiology — The outgrowth of deformity — Genu valgum — Description — Attitudes — Secondary deformities — Gait — Unilateral deformity — Pathology — Treatment — expectant — mechanical — operative — Genu varum, Varieties — Symptoms — Treatment — Expectant — mechanical — operative — Anterior bow leg — General rhachitic distortions 405

Chapter XVI. Deformities Of The Upper Extremity

Congenital dislocation of the shoulder — Obstetrical paralysis — Recur rent dislocation of the shoulder — Congenital deformities of the elbow — Cubitus valgus — Cubitus varus — Subluxation of the wrist — Club hand — Varieties — Club hand associated with defective development — Congenital contraction of the fingers — Webbed fingers — Trigger finger — Mallet finger — Baseball finger — Dupuytren's contraction 430

Chapter XVII. Diseases Of The Nervous System

Acute anterior poliomyelitis — Pathology — Etiology — Statistics — Symptoms — Causes of deformity — Deformity iu various regions — Subluxation — Retardation of growth — Treatment, mechanical, operative... 440

Chapter XVIII. Diseases Of The Nervous System, Continued

Cerebral paralysis of childhood — Description — Distribution — Etiology — Pathology — Symptoms — Congenital paralysis — Acquired paralysis — Treatment — Prognosis — Progressive muscular atrophy — Varieties — Symptoms — Hereditary ataxia — Neuritis — Functional affections of the joints — " Hysterical " hip — Differential diagnosis — " Hysterical ' ' club foot — u Hysterical ' ' scoliosis — Neurotic joints 459

Chapter XIX. Congenital And Acquired Torticollis

Description — Statistics — Congenital torticollis — Eti ology — Hsematoma of the sterno-mastoid muscle — Acquired torticollis — Varieties — Acute

CONTENTS. xi

torticollis — Etiology — Symptoms — Diagnosis — Treatment of torticollis — chronic, acute — Spasmodic torticollis — Etiology — Pathology — Treatment — Exceptional forms of torticollis — paralytic — diphtheritic — cervical opisthotonos, rhachitic — ocular — psychical 474

Chapter XX. Disabilities And Deformities Of The Foot

General description of the foot and of its functions, the arches, the foot as a passive support, in activity — Improper postures — Movements — Function of the muscles — Strength of the muscles — The foot as a mechanism — The weak foot or so-called flat foot — Description — Anatomy — Pathology — Etiology — Statistics — Symptoms — Diagnosis — Varieties — Weak foot in childhood — Treatment, preventive — Exercises — Support — Construction of brace — The rigid weak foot — Forcible correction of deformity — Subsequent treatment — Adjuncts in treatment — Operative treatment . 492

CHAPTER XXL

DISABILITIES AND DEFORMITIES OF THE FOOT, CONTINUED.

The hollow foot — Anterior metatarsalgia — Achillo bursitis — Achillo-bursitis posterior — Strain of the tendo Achillis — Calcaneo-bursitis — Plantar neuralgia — Erythromelalgia — Hallux rigidus — Hallux varus — Pigeon toe — Hallux valgus — Hammer toe — Overlapping toes — Exostoses — Displacement of the peronei tendons — Shoes, effects of improper shoes — Demonstration of the proper shoe 530

Chapter XXII. Deformities Of The Foot

Talipes — Description — Varieties — Statistics of talipes, congenital and acquired — Relative frequency of the different varieties — Congenital talipes — Etiology — Anatomy — Symptoms — Principles of treatment of infantile club foot — Treatment — mechanical — by plaster bandage — by braces— restoration of function — supervision — Treatment in older subjects — forcible manual correction — tenotomy — Wolff ? s treatment, reduction of deformity by wrenches — Phelps' operation — Operations on the bones — Mechanical treatment — Other varieties of congenital talipes — varus — equinus — calcaneus — valgus — equino-valgus — calcaneo-valgus — calcaneo-varus — equino-cavus — valgo-cavus — cavus— Congenital talipes associated with defective development — with absence of fibula — with absence of tibia — with defective formation of the foot— Constricting bands — Congenital amputation — Congenital oedema — Spina bifida and talipes '. 560 xii CONTENTS.

Chapter XXIII. Deformities Of The Foot, Continued

Acquired talipes — Etiology — Diagnosis — Talipes equinus — Description — Etiology — Symptoms — Treatment — mechanical— operative— Talipes calcaneus — Description, development of deformity— Symptoms — Treatment — mechanical, operative — Willett's operation — astraga lectomy — Talipes equino-varus and talipes equino valgus — Other varieties of acquired talipes — Tendon transplantation in the treatment of paralytic talipes — Tendon splicing — Arthrodesis 609

Orthopaedic Surgery.