Reports of Societies

1850 BMJ (Clinical Research Edition)  
referring to the operation of tenotomy, as practised not unfrequently on the Continent in cases of fracture, when unusual difficulty is experienced in reducing and keeping quiescent the fractured ends of a bone, the author related the following cases illustrative of this practice, where the tibia and fibula were the seat of injur, and the Tendo Achillis that of the operation. He believes they are the only instances thus treated in this country. The first case is funished by Mr. Shaw, in whose
more » ... r. Shaw, in whose practice it occurred :-W. S., aged 40, was admitted into the Middlesex Hospital on Feb. 12, 1847, having fallen down stairs in a state of intoxication. Both bones of the leg were broken, and the facture of the tibia extended through both malleoli, the foot being twisted outwaXds. Violent spasms of the muscles frustrated all attempts to keep the fractured extremities of the bones im apposition; the slightest movement brought on this spasmodic contraction, which extended to all the musCles of the limb, so as to cause great distortion of the foot, and render the skin over the base of the tibia extremely tense. All the symptoms continuing unabated on the following day, and the suffering of the patient being considerable, Mr. Shaw determined on dividing, in the usual way, the Tendo-Achillis, which was very tense. After this, all the difficulties entirely ceased, and no further trouble was experienced in the treatment of the case. The second case occurred in the author's own practice. The patient was a female, aged sixty-six, of drunken habits, and was admitted into the Middlesex Hospital in March, 1849. She had been knocked down by a cab, and both bones of one leg were fractured a little above the ankle. The symptoms and condition of this patient were very similar to those of the last, and every mechanical and therapeutic measure which could be suggested to relieve the spasms was tried in vain. The author divided the Tendo Achillis on the ninth day, with instant relief to the suffering of the patient, and immediate removal of all untoward symptoms. In less than a month, the chasm left after division of the tendon, which was not very great, had disappeared; and a fortnight subsequently, she was able to walk on crutches, and the foot was free from deformit7. After some general remarks on the value of the operation in the foregoing cases in relieving suffering and spasm, the author proceeded to remark, that he thought so simple and harmless a proceeding as dividing the Tendo Achillis might be adopted with advantage in other cases of more fretluent occurrence, especially as the cure would not thereby be retarded. He concluded with noticing a remark of M. Bonnet's, that he has frequently divided the Tendo Achillis in cases of diseased anlejoint, where rest was imperative, and where' the heel was drawn up by the muscles inserted into it. MR. CHARLEs HAWKINS remarked, that as the occurrence of spasms during the first few days aftera fracture greatly interfered with the well-doing of the patient, the operation might be usefull performed; as it might also in other cases, in which fracture had not taken place. He had no fear of dhe elongation of the tendon, a result which he had never met with. Cases of fracture of the patella were, perhaps, in their results, less creditable to a surgeon than any other accident. The patient had rarely afterwards a useful limb, owing in a great measure, as he thought, to the impossibility of
doi:10.1136/bmj.s2-2.13.78 fatcat:btmofpnevnffjcxv7rhmvbmf4a