File:A treatise on orthopedic surgery (1903) (14578600547).jpg

Identifier: treatiseonorth00whit (find matches)
Title: A treatise on orthopedic surgery
Year: 1903 (1900s)
Authors: Whitman, Royal, 1857-
Subjects:
Publisher: Philadelphia and New York, Lea brothers & co.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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e peroneus brevis and tertius. The soft parts are drawnaside, the ankle and astragalonavicular joint are opened, and tie-attachments to the scaphoid, and, as far as possible, those at theinner and outer border, are divided. The foot i- then addnotedso that the head of the bone may be seized with forceps anddrawn upward, the interosseous Ligament and the internal lateralligament having been divided with curved scissors, and the bonei- removed. If after removal of the astragalus the deformity 782 ORTHOPEDIC smoERY. cannot be corrected, the anterior part of the os calcis or theexternal malleolus should be removed as well. A useful movablefoot may be obtained by this operation, but it by no means assuresthe patient from recurrence of deformity. It is never indicatedas a primary operation, in childhood at least. The varus shouldbe thoroughly corrected as a preliminary procedure ; then theresistance that the astragalus offers to dorsal flexion can beestimated (Fig. 476). Fig. 476. Fig. 477.
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After forcible correction and astraga-lectomy. (See Fig. 475.) Partially corrected club-foot, showingsecondary knock-knee. Cuneiform Osteotomy. The removal of cuneiform sectionsof bone from the outer border of the foot is sometimes indicatedwhen the deformity is of long standing, but the operation should1m secondary to other methods of correction. The aim should beto lengthen the cunt meted and shortened tissues on the innerborder of the foot to the extent required for reposition, not toremove bone to accommodate these shortened tissues. If thishas been shown to be impossible by ordinary means, thenremoval of bone may be indicated; but it is not often neces-sary in childhood or even in adolescence. If sufficient bone is DEFORMITIES OF THE FOOT. 783 removed from the adult foot to permit complete correction of thedeformity, relapse is not usual; but in childhood, as has beenstated, no operation will take the place of after-treatment. The treatment by cuneiform osteotomy as it is ordinar

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