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The correction of bony deformities through splitting of the bone
New Series
VOL.II, No. 1
Progress
feet suffrcientIy Iong to give the muscIes their active exercise. At the beginning _ of the fifth day he is made to run. The Gibney boot is now appIied to prevent any abnorma1 movements. FRANCISCO, C. B., Kansas City, tubercuIous hips in children tubercuIosis. J. &fissouri M. 1926, xxiii, 385.
MO. NonsimuIating A., Nov.,
EarIy diagnosis cannot be made definiteIy in cases of hip joint affections in chiIdren around ten years of age, but the absence of IocaI and constitutiona symptoms shouId suggest that the condition is not the resuIt of disease. Frequent roentgenograms are necessary in obscure cases. To mistake a non-tubercuIous hip for a tubercuIous subjects the chiId to a Iong period of unnecessary treatment. Francisco describes cases of atypica1 LeggCaIve-Perthes osteochondritis deformans coxae juvenilis. The etioIogica1 factor is the same, he says, as in the typica cases, which are now considered as developmentaL resuIting from some mechanica cause rather than from infection. KEY, ALBERT J., St. Louis. The treatment of tubercuIosis of the hip. J. Missouri M. A., Nov., 1926, xxiii, 388. The best resuIt obtainabIe in tuberculosis of the hip is a firm bony ankyIosis of the joint with the extremity in a good functiona position. In young child ren the treatment must be conservative. With our present methods a certain amount of destruction of the joint must be expected to occur whiIe the patient is under treatment. In chiIdren over ten years of age and in aduIts, ankyIosis should be attempted by operation, but before the arthrodesis is performed the patient shouId be buiIt up by heIiotherapy and diet, and the hip shouId be put in the position in which it is desired to obtain ankyIosis. Key describes a technique for performing an arthrodesis by the aid of osteoperiostea1 grafts. It is not an extra-articuIar arthrodesis, however, the joint being opened by a SmithPeterson approach, the cartilages removed, the bone surfaces refitted and the synovia1 Iining excised.
in Surgery
American
Journal
of Surgery
‘94
WREDEN, R. R., Leningrad. OsteopIastic support of the spine in Pott’s disease. Ann. Surg., Jan., 1927, Ixxxv, 35. The author describes two operative methods of treatment which, in addition to immobiIizing the affected section of the vertebra1 coIumn, aIso support it, and which are found practicaIIy possibIe when the disease is Iocated in the Iower section of the vertebra1 coIumn, i.e., in the Iumbar and the Iast two dorsa1 vertebrae. The method of transverse support may be appIied in cases of an affection of both the fourth and fifth Iumbar vertebrae or of either of them when, owing to their sagging, the spinous process of the fourth Iumbar vertebra is situated beIow the Iine connecting the uppermost points of the cristae iIiacae. Under a muscuIo-aponeurotic tunne1 a rafter cut from the tibia is inserted from one ihac crest to the other. The method of obIique support is appIied in cases of an affection of the Iast two dorsa1 or the first three Iumbar vertebrae and is performed by creating a trestIe consisting of two Iong osseous transpIants and fixing the Iower ends of the latter in the cristae iliacae. The upper ends of the trestIe are fixed in a crosswise manner beneath the process of the sound vertebra which is situated above the diseased section of the spine. After the operation is compIeted the patient is kept on his back for six weeks. By the end of the second week he is aIIowed to rest for an hour or two daiIy on his abdomen with a hard piIIow placed under his chest. After six weeks he is graduaIIy trained to sit and seven weeks after the operation he begins to waIk, having no need of any kind of corset. A support of the spine by means of an orthopedic corset in these instances is even contraindicated; for owing to the effect of the Ioad of the trunk the osseous rafter grows and consoIidates more rapidIy whereas the erectores trunci pIaced over it appear to be a vis a tergo securing a recIination which is most important under the circumstances. This method has been apphed in onIy IO cases. KIRSCHNER, M. Kiinigsberg. The correction of bony deformities through spIitting of the bone. (Der Ausgleich knocbener Verbildungen durch Aufsplitterung des Knocbens.) Med. Klin., Nov. 26, 1926, xxii, 1836. FoIIowing the suggestion made in a previous communication, the author has operated on
196
American JournaI of Surgery
Progress
about 100 cases of bony deformities subsequent to badIy heaIed fractures, rachitis, or old osteomyelitis. He has had uniformIy good resuIts. The procedure consists in spIitting the involved bone IongitudinaIIy in severa different pIanes. This is carried out with the aid of a tourniquet and as far as possibIe without interrupting the continuity of the periosteum. The bone ends are interdigitated and a cast is appIied. After the appIication of the cast, the bone is manipuIated into proper position and the cast is permitted to harden. At the end of fourteen days, the cast is again removed to permit the further correction of any existing bone deformity. The author believes that in this technique, there is Iess IikeIihood of non-union than by those in which the periosteum is freely incised. There is no danger of fat emboIus as his cases demonstrate. Because of the extensive spIitting of the bone there is marked tendency toward formation of a firm bony caIIus. SCHAFFER, ALEXANDER J., and ROTHMAN, PHILLIP E., Baltimore. The treatment of erysipeIas with bIood transfusion. Am. J. Dis. Child. Jan., 1927, xxxiii, I 16. Concerning the treatment of erysipeIas by transfusion, it is sometimes maintained that this resuIt, as we11 as the critica drop in scarlet fever foIIowing the injection of Dochez’ or Dick’s serum, is mereIy a manifestation of non-specific protein shock. This expIanation seems hardIy tenabIe in face of the fact that two of the patients received very Iarge doses of intraperitoneaIIy, serum, antistreptococca1 intramuscuIarIy and intravenousIy, with no effect, whereas transfusion shortIy afterward was foIIowed in both cases by immediate defervescence. It seems much more probabIe that a varying degree of immunity to Streptococcus erysipeIatis is acquired within the first few years of Iife as a resuIt of infections of the upper respiratory tract in which this organism takes part. This hypothesis wouId explain the aImost uniform fataIity of the infection at and shortly after birth, and the rapid decIine of the mortahty curve with advancing age. The fact that a certain smal1 percentage of aduIts die of erysipeIas shouId expIain why aduIt serum from a11 donors is not equahy efhcacious. ResuIts with erysipeIas serum from convaIescent patients speak for this expIanation. It has been consistentIy noted that in the successfuIIy treated patients, the margin continues to spread for from tweIve to twenty-four hours
in Surgery foIIowing the treatment, after which the whoIe Iesion fades rapidly, just as the diphtheritic membrane continues to grow for the same Iength of time before it IinaIIy disappears after antitoxin. A series of IOI cases of erysipeIas in infants and in chiIdren is reported. Nineteen of these were treated by the intravenous transfusion of whoIe titrated bIood. The mortaIity in the treated group is distinctIy Iower than that in the contro1 group. SUPPLEMENTARY ABSTRACTS ROENTGENOGRAPHY AND RADIUM. THERAPY
ON
ABRAMOWITSCH,F. M., and TICHOMIROW,S. A. On the introduction of the contrast materia1 (IipiodoI) into the bronchi. Forts&. a. d. Geb. d. RSntgenstrablen, January, 1926, xxxiv, 22-25. The empIoyment of IipiodoI for the diagnosis of such conditions as bronchiectasis and puImonary abscess is without danger to -the patient. Contraindications to its use are the existence of kidney disease, and poor genera1 condition of the patient. The shadow-producing properties of IipiodoI permit an exact visuaIization in vivo of the anatomica and pathoIogica1 picture of the trachea and bronchi and their ramifications. With it one can observe dispIacement of the trachea and bronchi, diIatation and stenosis, excavation, cavitation and abscess formation. This is of the utmost importance before surgica1 intervention; and where the ordinary cIinica1 diagnosis is not cIear, the use of IipiodoI becomes . _ imperative. _. . _. . _ _ In septrc putrrd condrtrons, lrprodol appears to have a favorabIe therapeutic effect. The authors have administered the IipiodoI directIy through the Iarynx and regard this procedure as the simplest and Ieast dangerous, especially if repeated injections are necessary. Two cases are brieffy cited. ARENS, ROBERT A., and BLOOM, ARTHUR R. CongenitaI stenosis of the esophagus in a woman aged 67: InvoIvement of cardia and middIe third. Radiology, February, 1926, vi, 163-165. A case is reported in a woman aged sixtyseven. The physical examination reveaIed nothing of importance other than that the patient was under-nourished, weighing g7 pounds. A No. 30 bougie was passed easiIy whiIe a No. 34 met with obstruction at 42 cm. A roentgenoscopic examination discIosed a marked diIatation of the esophagus in its upper third extending down to the Ievel of the angIe of Ludwig.
VOL.II, No. 1
Progress
feet suffrcientIy Iong to give the muscIes their active exercise. At the beginning _ of the fifth day he is made to run. The Gibney boot is now appIied to prevent any abnorma1 movements. FRANCISCO, C. B., Kansas City, tubercuIous hips in children tubercuIosis. J. &fissouri M. 1926, xxiii, 385.
MO. NonsimuIating A., Nov.,
EarIy diagnosis cannot be made definiteIy in cases of hip joint affections in chiIdren around ten years of age, but the absence of IocaI and constitutiona symptoms shouId suggest that the condition is not the resuIt of disease. Frequent roentgenograms are necessary in obscure cases. To mistake a non-tubercuIous hip for a tubercuIous subjects the chiId to a Iong period of unnecessary treatment. Francisco describes cases of atypica1 LeggCaIve-Perthes osteochondritis deformans coxae juvenilis. The etioIogica1 factor is the same, he says, as in the typica cases, which are now considered as developmentaL resuIting from some mechanica cause rather than from infection. KEY, ALBERT J., St. Louis. The treatment of tubercuIosis of the hip. J. Missouri M. A., Nov., 1926, xxiii, 388. The best resuIt obtainabIe in tuberculosis of the hip is a firm bony ankyIosis of the joint with the extremity in a good functiona position. In young child ren the treatment must be conservative. With our present methods a certain amount of destruction of the joint must be expected to occur whiIe the patient is under treatment. In chiIdren over ten years of age and in aduIts, ankyIosis should be attempted by operation, but before the arthrodesis is performed the patient shouId be buiIt up by heIiotherapy and diet, and the hip shouId be put in the position in which it is desired to obtain ankyIosis. Key describes a technique for performing an arthrodesis by the aid of osteoperiostea1 grafts. It is not an extra-articuIar arthrodesis, however, the joint being opened by a SmithPeterson approach, the cartilages removed, the bone surfaces refitted and the synovia1 Iining excised.
in Surgery
American
Journal
of Surgery
‘94
WREDEN, R. R., Leningrad. OsteopIastic support of the spine in Pott’s disease. Ann. Surg., Jan., 1927, Ixxxv, 35. The author describes two operative methods of treatment which, in addition to immobiIizing the affected section of the vertebra1 coIumn, aIso support it, and which are found practicaIIy possibIe when the disease is Iocated in the Iower section of the vertebra1 coIumn, i.e., in the Iumbar and the Iast two dorsa1 vertebrae. The method of transverse support may be appIied in cases of an affection of both the fourth and fifth Iumbar vertebrae or of either of them when, owing to their sagging, the spinous process of the fourth Iumbar vertebra is situated beIow the Iine connecting the uppermost points of the cristae iIiacae. Under a muscuIo-aponeurotic tunne1 a rafter cut from the tibia is inserted from one ihac crest to the other. The method of obIique support is appIied in cases of an affection of the Iast two dorsa1 or the first three Iumbar vertebrae and is performed by creating a trestIe consisting of two Iong osseous transpIants and fixing the Iower ends of the latter in the cristae iliacae. The upper ends of the trestIe are fixed in a crosswise manner beneath the process of the sound vertebra which is situated above the diseased section of the spine. After the operation is compIeted the patient is kept on his back for six weeks. By the end of the second week he is aIIowed to rest for an hour or two daiIy on his abdomen with a hard piIIow placed under his chest. After six weeks he is graduaIIy trained to sit and seven weeks after the operation he begins to waIk, having no need of any kind of corset. A support of the spine by means of an orthopedic corset in these instances is even contraindicated; for owing to the effect of the Ioad of the trunk the osseous rafter grows and consoIidates more rapidIy whereas the erectores trunci pIaced over it appear to be a vis a tergo securing a recIination which is most important under the circumstances. This method has been apphed in onIy IO cases. KIRSCHNER, M. Kiinigsberg. The correction of bony deformities through spIitting of the bone. (Der Ausgleich knocbener Verbildungen durch Aufsplitterung des Knocbens.) Med. Klin., Nov. 26, 1926, xxii, 1836. FoIIowing the suggestion made in a previous communication, the author has operated on
196
American JournaI of Surgery
Progress
about 100 cases of bony deformities subsequent to badIy heaIed fractures, rachitis, or old osteomyelitis. He has had uniformIy good resuIts. The procedure consists in spIitting the involved bone IongitudinaIIy in severa different pIanes. This is carried out with the aid of a tourniquet and as far as possibIe without interrupting the continuity of the periosteum. The bone ends are interdigitated and a cast is appIied. After the appIication of the cast, the bone is manipuIated into proper position and the cast is permitted to harden. At the end of fourteen days, the cast is again removed to permit the further correction of any existing bone deformity. The author believes that in this technique, there is Iess IikeIihood of non-union than by those in which the periosteum is freely incised. There is no danger of fat emboIus as his cases demonstrate. Because of the extensive spIitting of the bone there is marked tendency toward formation of a firm bony caIIus. SCHAFFER, ALEXANDER J., and ROTHMAN, PHILLIP E., Baltimore. The treatment of erysipeIas with bIood transfusion. Am. J. Dis. Child. Jan., 1927, xxxiii, I 16. Concerning the treatment of erysipeIas by transfusion, it is sometimes maintained that this resuIt, as we11 as the critica drop in scarlet fever foIIowing the injection of Dochez’ or Dick’s serum, is mereIy a manifestation of non-specific protein shock. This expIanation seems hardIy tenabIe in face of the fact that two of the patients received very Iarge doses of intraperitoneaIIy, serum, antistreptococca1 intramuscuIarIy and intravenousIy, with no effect, whereas transfusion shortIy afterward was foIIowed in both cases by immediate defervescence. It seems much more probabIe that a varying degree of immunity to Streptococcus erysipeIatis is acquired within the first few years of Iife as a resuIt of infections of the upper respiratory tract in which this organism takes part. This hypothesis wouId explain the aImost uniform fataIity of the infection at and shortly after birth, and the rapid decIine of the mortahty curve with advancing age. The fact that a certain smal1 percentage of aduIts die of erysipeIas shouId expIain why aduIt serum from a11 donors is not equahy efhcacious. ResuIts with erysipeIas serum from convaIescent patients speak for this expIanation. It has been consistentIy noted that in the successfuIIy treated patients, the margin continues to spread for from tweIve to twenty-four hours
in Surgery foIIowing the treatment, after which the whoIe Iesion fades rapidly, just as the diphtheritic membrane continues to grow for the same Iength of time before it IinaIIy disappears after antitoxin. A series of IOI cases of erysipeIas in infants and in chiIdren is reported. Nineteen of these were treated by the intravenous transfusion of whoIe titrated bIood. The mortaIity in the treated group is distinctIy Iower than that in the contro1 group. SUPPLEMENTARY ABSTRACTS ROENTGENOGRAPHY AND RADIUM. THERAPY
ON
ABRAMOWITSCH,F. M., and TICHOMIROW,S. A. On the introduction of the contrast materia1 (IipiodoI) into the bronchi. Forts&. a. d. Geb. d. RSntgenstrablen, January, 1926, xxxiv, 22-25. The empIoyment of IipiodoI for the diagnosis of such conditions as bronchiectasis and puImonary abscess is without danger to -the patient. Contraindications to its use are the existence of kidney disease, and poor genera1 condition of the patient. The shadow-producing properties of IipiodoI permit an exact visuaIization in vivo of the anatomica and pathoIogica1 picture of the trachea and bronchi and their ramifications. With it one can observe dispIacement of the trachea and bronchi, diIatation and stenosis, excavation, cavitation and abscess formation. This is of the utmost importance before surgica1 intervention; and where the ordinary cIinica1 diagnosis is not cIear, the use of IipiodoI becomes . _ imperative. _. . _. . _ _ In septrc putrrd condrtrons, lrprodol appears to have a favorabIe therapeutic effect. The authors have administered the IipiodoI directIy through the Iarynx and regard this procedure as the simplest and Ieast dangerous, especially if repeated injections are necessary. Two cases are brieffy cited. ARENS, ROBERT A., and BLOOM, ARTHUR R. CongenitaI stenosis of the esophagus in a woman aged 67: InvoIvement of cardia and middIe third. Radiology, February, 1926, vi, 163-165. A case is reported in a woman aged sixtyseven. The physical examination reveaIed nothing of importance other than that the patient was under-nourished, weighing g7 pounds. A No. 30 bougie was passed easiIy whiIe a No. 34 met with obstruction at 42 cm. A roentgenoscopic examination discIosed a marked diIatation of the esophagus in its upper third extending down to the Ievel of the angIe of Ludwig.