Removal of both astragali in a case of severe double talipes / by Edward Lund.

  • Lund, Edward, 1823-1898.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Removal of both astragali in a case of severe double talipes / by Edward Lund. 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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    the bone, that it was nearly impossible to be certain whether or not all the fibres were divided and the head of the bone fully exposed ; this, however, being done, I tried with a gouge to raise the bone, while the scaphoid and the front part of the foot were bent backwards ; and, in doing this, I cut off a thin piece of the edge of the cup of the scaphoid — there was so little space between the bones for the passage of the in- strument, that it cut into the soft young bone. The same accident oc- curred when I used the gouge between the external malleolus and the side of the astragalus ; for here, again, from want of space, I detached unwittingly a slice of the inner side of the malleolus, as the preparation will show. Fortunately, I had provided myself with a little instrument, which I here found very useful. It is a small, strong, curved hook, fixed in a stout handle (Fig. e) ; and it has on its concavity a cutting edge, while the edge of the hook is round and blunt.* This hook I used as a lever to raise up the astragalus, and lift it from the bed or socket formed for it by the scaphoid, upper surface of the calcaneo- scaphoid ligament, and the os calcis ; and, passing it round one end of the calcaneo-astragaloid ligament between the bones, by simple trac- tion, I cut through the interosseous band in its whole length. This proved to be the key of the operation ; for, after its division, I could dislodge the astragalus, and, holding it firmly with Sir William Fer- gusson’s lion-forceps, made a few touches with the cutting hook, used first as a wedge between each side of the astragalus and corresponding mal- leolus to separate the bones, and then as a cutter to divide the bands of the lateral ligaments ; the bone was thus set free and drawn out easily. There was little, if any, impediment from fibres at the back of the astragalus, and none at all, as I had anticipated, from adhesions of the tendon of the flexor longus pollicis to the sheathed groove in the bone ; for, in fact, the groove itself was very shallow, and but poorly de- veloped. I need not say that, in operating on the right foot, I used only the cutting hook, and not the gouge or chisel, to detach the astragalus from its ligaments ; so that, in this foot, I did not injure the neighbouring bones nor remove any portions of them. The operation on each foot was conducted, from first to last, in strict accordance with those principles of antiseptic surgery which are well known as Mr. Lister’s method. Catgut ligatures were used on two small arteries which were tied—the carbolised wax and resin sutures to * It is very similar to the guarded cutting hooked knife which I show in the museum collection as useful for the division of internal blind fistulse.