ulufuso aqunili
|
 |   Related post: 809 One patient from Fort Monroe writes me tliat tlie braces served to straighten the foot and hold it so, and that witli a little counter in the shoes he has been able to dispense with all apparatus. There was one case traced where there was no tendon transplantation, but simply this shorten- ing above mentitoned, and the result at the end of five months was negative. Two casus presented feet with muscles so much paralyzed that the following operation was done: Through the anterior \ertical incision tendons along the front of the foot were shortened and sewed firmly to the annular ligament so as to limit the motion. The result in one at the end of a year and a half was fair; that is, the patient could make voluntary flexion to 90" without abducting the foot. Flexion beyond this point was accompanied by a little abduction. In the other case the result was negative. Two cases were subjected to the operation of transplanting tendons into periosteum. One of these at the end of four months showed an excel- lent result, and is marked "good." The other was "fair" at the end of about the same period. Many years ago the writer of this paper presented sta- Nevirapine Tablets tistics showing results of shortening of the tendo Achillis. This operation was done for calcaneus, and the overlapped tendon was suturedto flaps of the wound on closing. There was no tendon transplantation in these cases, but in the list now analyzed there were thirteen operations done for limiting the range of motion in the foot and for correcting this same deformity of calcaneus. Through the anterior and posterior incisions, with tunnelling of the skin on either side of the lower portion of the leg, anterior and posterior ten- dons were sutured one to another. For instance, where the tendo Achillis was weak the tibialis an- titcus or a portitoVi of it, in some instances one or more divisions of the extensor longus digitorum, were sutured to the tendo Achillis. In other in- stances, where the anterior muscles were weak, the stronger but still .elongated tendo Achillis was passed through these same tunnels and su- tured to the muscles on the anterior aspect of the foot, the extensor proprius hallucis or the tibialis anticus. Of twelve traced, si.x were good, four fair, and two negative. One case of calcaneo-valgus with complete par- alysis of all the posterior muscles was subjected to the following operation, which is interesting as showing a very fair result. A curved incision was made around the outer side of the foot, the tendo Achillis was split like a buttonhole, the peroneus brevis was detached from its insertion, the peroneus longus was ctit near the muscular at- tachment and the distal end pulled up and passed through this buttonhole ui the tendo Achillis, where it was securely sutured. The proximal ends were also sutured to the tendo Achillis. All these procedures followed enucleation of the astralgulus through this same opening. Primary union oc- curred, and at the end of six months the foot was held at right angles in moderate equinus. A brace was employed to avoid overstretching. One of the patients shown this evening had an operation like the following: A straight incision was made under the external malleolus, the astra- galus was removed en bloc, the peroneus brevis was cut at its insertion and passed through the joint and inserted to the periosteum of the scaph- oid, and to the tii)ialis posticus at its insertion. The Buy Nevirapine tendon of the peroneus longus was cut at its in- sertion and taken out of the groove and passed through a hole drilled through the oscalcis and finally sutured to a portion of a muscle so as to make a kind of checkrein on the posterior portion of the foot. The result at the end of a year is very good. The patient has very fair flexion and extension of the foot, practically no calcaneus, and but for a par- alysis of the thigh nniscles he would be able to walk without apparatus. The foregoing gives a very fair idea of the technics employed in operations about the ankle for drop-foot, known as equinus, e(|uino-varus, equino-valgus, valgus and calcaneus. The operations for dangle-leg have been five in number. These consist of an incision over the outer and lower third of the femur extending down the tibia, so that the insertion of the sartor- ius and short head of the biceps may be exposed. The attachments are dissected out quite carefully and the distal ends passed through a buttonhole in the tendinous portion of the quadriceps femoris, sometimes passed through one or two and sutured to the muscles on the inner or outer side. In the five cases tjie immediate results were fair, that is, the sartorius or biceps seemed to aid the quadri- ceps, but later results were negative. There were fi\^i cases traced. The operation for the relief of drop-wrist prom- ises even better results than our records show, be- cause the technic of the operation is yet incom- plete. The procedures thus far employed are lat- eral incisions, one over the radial border and one over the ulnar border, with detachment of the llexor tendons and the insertion of the same into the extensor tendons. Again, the anterior and posterior incision about the middle and lower third of the forearm dissection through the interos- seous space, so that the flexor tendons may be transmitted to the extensor tendons. There have been six cases, with one good result, three fair, and two negative. It would seem as if the distal ends of the sutured tendons might be attached to other 8lO Related links: buy generic prozac online no prescription, Can You Get Zithromax Over The Counter, Erythromycin Cheap Online, Toprol Xl 12.5 Mg, Benzoyl Peroxide Wash 5, xenical 120, Purchase Femara Online, cheapest place buy alligator clips, Chlorpromazine Price, Buy Captopril Online
|