A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins.

  • Makins, George Henry, 1853-1933.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: A case of extroversion of the bladder treated by preliminary narrowing of the gap existing in the pubic symphysis by means of division of the sacro-iliac synchondroses / by G.H. Makins. 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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    8. Lastly; Prof. Trendelenburg expresses the hope that in some of these cases the sphincter apparatus may still exist; and that by union of the posterior portion of the urethra a fairly retentive viscus may be obtained. The chief objection no doubt lies in the possible weak- ening of the joints. On this matter I can only say that my own patient walks well, and that in Prof. Trendelen- burg’s cases the same result has been noted. I would point out; however; that although the posterior, interosseous, and superior ligaments are divided, that the ilio-lumbar and sacro-sciatic ligaments remain entire. The latter would still be equally able to resist possible rotation of the sacrum forwards, the ilia being connected and fixed above by the ilio-lumbar ligaments to the transverse process of the last lumbar vertebra, and moreover the slightly increased forward obliquity of the latter ligaments would tend to prevent displacement of the sacrum back- wards, or movement of the ilia forwards ; the latter rotating forwards in the movement approximating the anterior superior spines on the combined axes of this ligament and the anterior margins of the joint. It must be remembered also that during the main- tenance of the compression, although the posterior aspects of the joints are caused to gape, yet the compression is lateral, and consequently the irregular surfaces offered by the opposing bones would still tend to prevent gliding movements in either direction, the division of the joint- union having of necessity followed to a considerable extent these inequalities. As to the mode of repair, the gap must at first neces- sarily become filled with soft connective tissue, and for the fulfilment of this object slight suppuration, such as occurred in my case, is perhaps to be regarded as favor- able. I would point out, however, that the result of the compression is to relieve the ossifying structures bounding the posterior aspect of the joint from pressure, while pressure is considerably increased in the anterior segment. Reasoning' from the analogy of what is observed in the