A treatise on orthopedic surgery

Front matter

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Preface To The Third Edition

This volume presents a thorough revision and amendment of the last edition. New material and many illustrations have been added, and the author trusts that it fairly represents this department of medicine at the date of issue.

283 Lexington Avenue, New York, December, 1906.

FROM THE PREFACE TO THE FIRST EDITION.

In the preparation of this volume it has been the purpose of the author to present as adequately as might be the practice of Orthopedic Surgery of the present day.

The student of this subject 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 with its general influence upon the entire mechanism, and with its ultimate consequences as well.

Orthopedic 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 vi PREFACE

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 Orthopedic Surgery as far as possible objectively, and in a manner that has proved acceptable to 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 orthopedic 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; but the particular methods of the application of these principles, which have been described in detail, are always 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 which he hopes may prove of interest to his fellowworkers 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.

Chapter I. Tuberculous Disease Of The Spine

PAGE

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 and overextension — by braces — by plaster 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) — Recurrence of Disease — Secondary deformities — Recapitulation. 17

Chapter II. Non-tuberculous Affections Op The Spine

Syphilis — Malignant disease — Osteomyelitis, acute and chronic — Actinomycosis — Injur}' — Traumatic spondylitis — Rhachitic spine — Typhoid spine — Gonorrhceal arthritis of the spine — Arthritis — Spondylitis deformans, varieties — Osteitis deformans — Spondylolisthesis — Relaxation of pelvic joints — Pain in the back — Neurotic spine — Hysterical spine — Sciatic scoliosis — Disease and injury at the sacroiliac articulation 126

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 — Desks, chairs — Principles of treatment — Treatment — by exercises — general exercises — heavy exercises — special exercises — Supports. Forcible correction of deformity — Adjuncts in treatment — Duration of treatment 149

CHAPTER D7.

DEFORMITIES OF THE SPINE (CONTINUED). DEFORMITIES OF THE CHEST FUNCTIONAL PATHOGENESIS OF DEFORMITY.

Variation in contour of the spine — The round and the flat back — Kyphosis ' — Lordosis — Treatment — Congenital elevation of the scapula. — viii CONTENTS

PAGE

Absence of vertebrae — Flat chest — Pigeon chest — Funnel chest — Minor deformities — Cervical Ribs — Scapular Crepitus — 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) — Atrophy of bone — Hypertrophy of bone .... 223

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 — synovial — arborescent, synovial form — lipoma arborescens — rice bodies — caries sicca — Septic infection— Progress and method of repair — Prognosis — Treatment — operative and mechanical — by drugs — local applications — Iodoform filling — X-ray — Active and passive congestion — venous stasis (Bier's treatment) 246

Chapter VI. Non-tuberculous Diseases Of The Joints

Syphilitic disease of joints — Gonorrhoeal arthritis — Other forms of infectious arthritis — Acute epiphysitis — acute osteomyelitis — Subacute osteomyelitis — Osteoarthritis and rheumatoid arthritis — Varieties — ■ Treatment — Still's disease — Gout — Rheumatism — Haemophilia — Haemarthrosis — Scorbutus — Charcot's disease — Other forms of arthropathy — -Anchylosis — Treatment 266

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's table — Kingsley's table — Explanation of physical signs — Differential diagnosis — Principles of treatment — The traction hip brace — The Thomas brace — The plaster bandage — Various methods of reducing deformity — Comparison of methods of treatment — The long hip splint — The hip splint and the plaster spica — Other forms of apparatus — Bilateral hip disease — Hip disease in infancy — Hip disease in adult life — Abscess — statistics — treatment — Operative treatment — exploration — excision — reduction of resistant deformity — Prognosis, mortality, functional results — Secondary deformities of hip disease—Treatment — -Final results 298

Chapter VIII. Non-tuberculous Affections Of The Hip-joint

Statistics — Traumatisms at the hip — Acute infectious arthritis — Subacute arthritis — Spontaneous dislocation — Gonorrhoeal arthritis—

CONTENTS ix

PAGE

Extra-articular disease — Bursitis — Malignant disease at the hip-joint

— Cysts of the femur — Arthritis deformans 398

Chapter IX. Tuberculous Disease Of The Knee-joint

Pathology — Etiology — Statistics — Symptoms, primary and secondary distortions — Shortening and lengthening — Diagnosis — Differential diagnosis — Treatment — Reduction of deformity — Forms of braces — Accessories in treatment — Extra-articular disease — Abscess — Operative treatment — arthrectomy — excision, amputation — Prog

■\. nosis — mortality — functional results — General conclusions . . . 406

Chapter X. Non-tuberculous Affections Of The Knee-joint

Injury in childhood — Acute Synovitis — Chronic Synovitis — Internal derangement of the knee-joint — Prepatellar bursitis — Pretibial bursitis — Injury of tibial tubercle — Bursse and cysts in the popliteal region — Hyperplasia — Quiet effusion — Acquired genu recurvation — Congenital genu recurvatum — rudimentary or absent patella — Congenital displacement of patella — Slipping pateUa — Elongation of the ligamentum patella? — Snapping knee — Congenital contraction at the knee — General contractions 434

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 — Chronic sprain — Swelling about the ankles — Tenosynovitis — Other affections of the ankle-joint 450

Chapter XII Diseases And Injuries Of The Articulation 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 at the shoulder-joint — Chronic bursitis at the shoulder — Sprain of the wrist — Acute and chronic tenosynovitis at the wrist 466

Chapter XIII. Deformities Of The Upper Extremity

Congenital dislocation of the shoulder — Obstetrical paralysis and dislocation — Treatment — Operation on Brachial plexus — Recurrent x CONTENTS

PAGE

dislocation of the shoulder — Congenital deformities of the elbow — Cubitus valgus — Cubitus varus — Subluxation of the wrist — Congenital deformities at the wrist — Club-hand— Varieties — Treatment — Club-hand associated with defective development — Congenital contraction of the fingers — Webbed fingers — Congenital displacement of phalanges — Trigger finger— Mallet finger — Base-ball finger — Dupuytren's contraction 482

Chapter XIV. Congenital And Acquired Affections Leading To General Distortions

Rhachitis — Etiology — Pathology — Symptoms, deformities — Prognosis- Treatment — " Late rickets" — Chondrodystrophia — Infantile scorbutus — Fragilitas ossium — Osteomalacia — Osteitis deformans — Secondary hypertrophic osteo-arthropathy — Acromegalia . . . 498

Chapter XV. Congenital Dislocation Of The Hip And Coxa Vara

Congenital dislocation of the hip-joint — Statistics — Pathology — Etiology — Symptoms, unilateral, bilateral — Anterior — Supracotyloid — Diagnosis — Differential diagnosis — Treatment — the Lorenz operation — ■ Details and modifications— Prognosis — Treatment of older subjects — Treatment in infancy — Palliative treatment — The open operation Arthrotomy— the intermediate operation — secondary osteotomy — The Hoffa-Lorenz operation — Review of treatment — Variations in treatment — Congenital subluxation of the hip — Snapping hip — Coxa vara— Pathology — Etiology — Statistics — Symptoms, unilateral, bilateral— Diagnosis — Treatment — mechanical — operative — Forcible abduction — Osteotomy — Cuneiform — Linear — Fracture of the neck of the femur — Traumatic separation of the epiphysis of the head of the femur — Partial epiphyseal separation — Fracture in adult fife — The author's treatment for complete — for impacted — Coxa valga 513

Chapter XVI. 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 rheachitic distortions 569

Chapter XVII. Diseases Of The Nervous System

Acute anterior poliomyelitis — Pathology — Etiology— Statistics — Symptoms—Diagnosis — Prognosis — Causes of Deformity — Deformity in

CONTENTS various regions — Subluxation — Retardation of growth — Principles of Treatment — Treatment, mechanical, operative — Tendon and muscle transplantation — Arthrodesis— Nerve grafting — Recapitulation . 598

Chapter XVIII. Diseases Of The Nervous System (continued)

Cerebral paralysis of childhood — Description — Distribution — Etiology — Pathology — Symptoms — Congenital paralysis — Acquired paralysis — Hemiplegia — Paraplegia — Treatment, mechanical, operative — — Prognosis — Spastic spinal paraplegia — Progressive muscular atrophy — Varieties — Symptoms — Hereditary ataxia — Neuritis — Hysterical and functional affections of the joints — "Hysterical" hip — Differential diagnosis — " Hysterical" deformities — " Hysterical" club-foot — "Hysterical" scoliosis — Neurotic joints .... 623

Chapter XIX. Congenital And Acquired Torticollis

Description — Statistics — Congenital torticollis — Etiology — Hsematoma of the sternomastoid muscle — Acquired torticollis — Varieties — Acute torticollis — -Etiology — Symptoms — Diagnosis — Treatment of chronic torticollis — mechanical, operative — Treatment of acute torticollis — Spasmodic torticollis — Etiology — Pathology — Treatment — Exceptional forms of torticollis — paralytic — diphtheritic — cervical opisthotonos, rhachitic — ocular — psychical 642

j 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 — Exceptional forms — Treatment — Preventive — Exercises — Support — Construction of brace — The rigid weak foot — Forcible correction of deformity — Subsequent treatment — Adjuncts in treatment — Operative treatment . . . 665

Chapter XXI. Disabilities And Deformities Of The Foot (continued)

The hollow foot — Varieties and treatment — Anterior metatarsalgia — Morton' s neuralgia — Etiology — Treatment — Achillobursitis — Strain of the tendo Achilles — Calcaneobursitis — Plantar neuralgia — Erythromelalgia — Intermittent limp — Hallux rigidus — Painful great toe — Hallux varus — Pigeon toe — Metatarsus varus — Hallux valgus — Hammer toe — Overlapping toes — Fracture of metatarsus — Exostoses — Displacement of the peronei tendons — Shoes, effects of improper shoes — Demonstration of the proper shoe— Socks . . . 716 xii CONTENTS

Chapter XXII. Deformities Of The Foot

PAGE

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 — Astragalectomy — Osteotomy — Mechanical treatment — Other varieties of congenital talipes — varus — equinus — calcaneus — valgus — equinovalgus — calcaneo valgus — calcaneovarus — equinocavus — valgocavus — 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 752

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 — Willet's operation — The author's operation — Talipes calcaneovarus and calcaneo valgus — Talipes equinovarus and talipes equinovalgus — Talipes valgus — Traumatic valgus — Other varieties of acquired talipes — Tendon transplantation in the treatment of paralytic talipes — Tendon transplantation and arthrodesis — Tendon splicing — Arthrodesis and other procedures 813

ORTHOPEDIC SURGERY.