COMPOUND DISLOCATION OF THE KNEE-JOINT
;
RECOVERY WITHOUT AMPUTATION. By BHOOBUN MOHUjSt CHATTERJEE, Sub-Asst.-Surgeon, Maharajah's Dispensary, Bordwan. CojirouND dislocation of the knee-joint is an accident which is very rare tliat every instance is worthy of narration. It is one of the most formidable injuries to which the lower extremities The terrible laceration of the soft parts, with exare liable. tensive extravasation of blood ana the protrusion of the condyles of the femur through a large external wound, imperatively demand amputation of the limb. The extreme and almost irreparable destruction of parts induces authors and eminent surgeons, such as Sir A. Cooper, Erichsen, Taylor, Davies, Richards; and M. Roberts, to regard this injury as specially demanding primary amputation. But where the patient is young, and the vessels, tendons, and nerves do not appear to have been seriously damaged, my much respected teacher, Professor Fayrer, has taught me to make every attempt to save the limb. I am induced to place on record the following case of compound dislocation of the knee-joint, not only as one of unusual occurrence, but also as one where the injured limb was cured by giviug nature much of her own way, and the recovery was complete, easy, and rapid. Sudcli aged 12, a slender-looking girl, sustained a compound dislocation of the knee-joint on April 20th, by falling under a pile of wood when playing with a number of compaSO
218
THE INDIAN MEDICAL GAZETTE.
nions; on the 24th she was brought to the Maharajah of Burdwan's Dispensary. I found her lying in a (holy with the
right leg tightly hound with a cloth from 3 or 4 inches below the knee, and to the same extent above. On examination, I found that the condyles of the femur protruded through a large
wound on the outer side of the limb. The bone is denuded of its periosteum and is out about 2 inches. It looks dry, and of a dirty white color. The soft parts are very mach bruised and lacerated, joint swollen and painful, ligaments ruptured, muscles, vessels, and nerves uninjured. The ligamentum patellae is forcibly drawn downwards by the flexors of the knee. No fracture of any of the bones composing the joint. The leg and foot retain their sensibility and temperature; pulse 100, soft and compressible ; tongue clean and moist; no pyrexia ; bowels not moved since the accident took place; passes urine freely. The projecting portion of the bone, about 2.} inches in length, was sawn off and reduced. The external wound was closed by three stitches, and dressed with cold lotion. The limb was put on splints and bandaged ; the bowels were relieved by castoroil, and opiates were given at night. loth.?Patient feels comfortable; pain much less ; swelling less. The friends request to take the patient home, and the patient herself is very anxious to leave the dispensary. 26th.?Discharged at her own request. Although the patient was taken home, her friends used to She come to me every now and then to take my directions. gradually improved without a bad symptom. On the 28th July, 1865, the patient was brought to my house, when I had an opportunity of examining the limb. The wound was quite cured; limb somewhat shortened. The tendons of the flexor muscles of the ham were found to be stiff and contracted, and the Knee straight. She could stand by holding a lati, but was still unable to walk about. Unfortunately the patient died of in December last. dysentery
[August 1,
1866.
;
RECOVERY WITHOUT AMPUTATION. By BHOOBUN MOHUjSt CHATTERJEE, Sub-Asst.-Surgeon, Maharajah's Dispensary, Bordwan. CojirouND dislocation of the knee-joint is an accident which is very rare tliat every instance is worthy of narration. It is one of the most formidable injuries to which the lower extremities The terrible laceration of the soft parts, with exare liable. tensive extravasation of blood ana the protrusion of the condyles of the femur through a large external wound, imperatively demand amputation of the limb. The extreme and almost irreparable destruction of parts induces authors and eminent surgeons, such as Sir A. Cooper, Erichsen, Taylor, Davies, Richards; and M. Roberts, to regard this injury as specially demanding primary amputation. But where the patient is young, and the vessels, tendons, and nerves do not appear to have been seriously damaged, my much respected teacher, Professor Fayrer, has taught me to make every attempt to save the limb. I am induced to place on record the following case of compound dislocation of the knee-joint, not only as one of unusual occurrence, but also as one where the injured limb was cured by giviug nature much of her own way, and the recovery was complete, easy, and rapid. Sudcli aged 12, a slender-looking girl, sustained a compound dislocation of the knee-joint on April 20th, by falling under a pile of wood when playing with a number of compaSO
218
THE INDIAN MEDICAL GAZETTE.
nions; on the 24th she was brought to the Maharajah of Burdwan's Dispensary. I found her lying in a (holy with the
right leg tightly hound with a cloth from 3 or 4 inches below the knee, and to the same extent above. On examination, I found that the condyles of the femur protruded through a large
wound on the outer side of the limb. The bone is denuded of its periosteum and is out about 2 inches. It looks dry, and of a dirty white color. The soft parts are very mach bruised and lacerated, joint swollen and painful, ligaments ruptured, muscles, vessels, and nerves uninjured. The ligamentum patellae is forcibly drawn downwards by the flexors of the knee. No fracture of any of the bones composing the joint. The leg and foot retain their sensibility and temperature; pulse 100, soft and compressible ; tongue clean and moist; no pyrexia ; bowels not moved since the accident took place; passes urine freely. The projecting portion of the bone, about 2.} inches in length, was sawn off and reduced. The external wound was closed by three stitches, and dressed with cold lotion. The limb was put on splints and bandaged ; the bowels were relieved by castoroil, and opiates were given at night. loth.?Patient feels comfortable; pain much less ; swelling less. The friends request to take the patient home, and the patient herself is very anxious to leave the dispensary. 26th.?Discharged at her own request. Although the patient was taken home, her friends used to She come to me every now and then to take my directions. gradually improved without a bad symptom. On the 28th July, 1865, the patient was brought to my house, when I had an opportunity of examining the limb. The wound was quite cured; limb somewhat shortened. The tendons of the flexor muscles of the ham were found to be stiff and contracted, and the Knee straight. She could stand by holding a lati, but was still unable to walk about. Unfortunately the patient died of in December last. dysentery
[August 1,
1866.
