North Staffordshire Infirmary: Case of Exostosis of the Tibia, and Operation
BMJ (Clinical Research Edition)
RC.S., &c., latelv one of the Surgeons to the North Staffordshire Infimary. Joseph Hubball, agricultural labourer, aged 21, married, of florid complexion and healtby appearance, was admitted into the North Staffordshire Itnfirmary, January 5th, 1846. About two years and a half ago, h4s attention was first called to a " lump" in the upper and back part of the right leg, by uneasiness in the prt, which was attended with occasional numbness in the ankle; there is no very marked swelling of the
... swelling of the part, bnt the muscles of the calf, on examination, seem to be stretched, and a hard tumour can be felt firmly attached to the upper and posterior part of the tibia. A pulsating blood-vsssel can be traced on the outer edge of the tumour. The patient thinks the swelling may have been caused by leaping. Leeches, blisters, and other measures had been resorted to before his admission. He was directed to take Potassii lodidi, ,gr. iv., twice a day, and he had a strong compound iodine solution to Apply to the tutnour. This plan was unremittingly pursued till the middle of April, but the tumour had become decidedly larger, and the patient was now suffering considerable pain. A consultation of my colleagues was therefore called, when I submitted for their consideration a proposal to remove the tumour by excision; this was decided upon, and the operation undertaken, May-2nd. A free Incision, commencing at the lower-part of the poplltieal space, and within the inner hamstring, was exteiuded about four inches downwards, on the inner edge of the gastrocnemius, and parellel with it. This ias continued across the muscle, and carried a little upwrards, so that the cut had somewhat of a hooked appearance. By this means, a flap was formed of the muscles of the calf, which was -turned upwards; two bleeding wessels were tied at this stage of the operation. The tumour now became apparent, covered only by an expansion of muscular fibres. The house-surgeon, Mr. S. Alfordt having drawn aside the vessels and nerve, by means of a hooked copper spatula, the muscnlai fibres were di%ided so as to expose the tumour clearlv; it had anl extensive attachment to the tibia, and overhung its inner edge, so as to fill up the interosseal space at this part. By means of a chisel and mallet applied to its inner edge, it was partially divided; the chisel was then wor-ked inito the internal structtTre of the tumotur, witlh the hand alone, and by raising the handlle of the instrument, the bony mass was forced from its attachment; a few projectinig points of bone were renmoved by the bone-nipper. Some linlt having been applied to the bottom of the wounid, the muscular fldp was laid down, and a piece of lint placed over it, and this being retained by a bandage looselv applied, the patient was carried to his bed. Sum.t Tinct. Opii, min. xxv. e Mist. Camph., oz.j. stati,n. Hydrarg. Chlor., gr. iv., hora somni. 9 The operation was efected with much less difficulty than was anticipated. The tuauour was as large as a middlle-sized potato, had a nodulated appearance, and a flesh colour, having somewhat the resemblance of large granulations; but this appearance was only superficial; internally it had a cancellated bony structure. The diameter of its base was nearly tbree inches. May 3rd. The limb somewhat swelled; the bandage and outer dressings were removed, and lint soaked in warm water applied.