Subcutaneous section of the internal condyle of the femur for the relief of genu-valgum, after the method of Ogston : with a report of two cases : also, remarks upon the operative treatment of this deformity / by Geo. R. Fowler and Lewis S. Pilcher.

  • Fowler, George R. (George Ryerson), 1848-1906.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Subcutaneous section of the internal condyle of the femur for the relief of genu-valgum, after the method of Ogston : with a report of two cases : also, remarks upon the operative treatment of this deformity / by Geo. R. Fowler and Lewis S. Pilcher. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    maintains its normal position and relations; partially extended, the tibia rotates obliquely outwards, and in full extension the lengthened internal condyle fills up the space which would otherwise exist between it and the head of the tibia, and the normal axis of the limb, as a whole, is destroyed. In the treatment of this deformity nothing can be gained by waiting for Nature to right the limb. Spontaneous recovery never takes place, and mechanical treatment is frequently of no avail, unless conjoined with division of the tendon of the biceps. As long as there is lateral move- ment to the knee-joint something may be gained by attempting to restore the normal axis of the limb by mechanical means, together with tenotomy of the external hamstring. But when no lateral movement can be de- monstrated to exist, other operative measures become necessary. The earlier attempts to correct this deformity by operative procedure other than tenotomy consisted of removal of a wedge-shaped piece of the head of the tibia by what was known as Meyer’s operation. This has been most emphatically and justly condemned as based upon incorrect and unsound principles. Knock-knee is not dependent in any way upon curvature or other alteration in the size and shape of the tibia. After the introduction of Lister’s methods of antiseptic surgery, opera- tions involving the opening of joints became more frequently resorted to, and attempts to correct genu-valgum by sawing off and removing the elongated internal condyle were made. This operation (Annandale’s), although based upon a knowledge of the anatomy and pathology of the deformity, did not become very popu- lar with surgeons, for the reason that it almost invariably resulted in a complete and incurable bony anchylosis of the knee-joint, and was finally abandoned. In 1876 Dr. Ogston, of Aberdeen, Scotland, proposed as a means of relief of this deformity an operation consisting of the subcutaneous divi- sion and fracture of the internal condyle of the femur, and a forcible straightening of the limb, thereby restoring the normal proportion in the length of the two condyles without removing any part of the articular surface. Subsequently, in The Edinburgh Medical Journal for March, 1877, he reported a case so operated upon in May, 1876, under the anti- septic spray of Lister, in which a perfect cure was accomplished. Mr. George W. Callender, of London, as well as other English surgeons, has since repeated the operation of Ogston—without the antiseptic spray, however—with the same excellent results. This operation, as performed by myself, is as follows: The limb being stiongly flexed and rotated outwards, an Adams tenotomy knife is en- tered about two inches and a half above the tip of the internal condyle