Paul C. Colonna

Operative approaches to the ankle joint

Abstract A resume of varied approaches to the ankle joint has been presented. The authors have not used all of them. Although personal preference has been given to certain ones of these, the purpose of this paper has been to review the anatomy and operative approaches to this joint and not advance one procedure over the other. It would seem well to realize that certain routes of approach can be best utilized under individual circumstances. When the surgeon has a clear understanding of the pathologic changes confronting him, he can then choose his method of approach.

Infantile cortical hyperostoses.

Abstract In all of the cases presented herein the disease occurred within the first six months of life. In Case v a definite swelling of the left side of the mandible was noted within the first month of life. Hyperirritability, swelling and tenderness are important clinical manifestations of this disease. The syndrome appears to be a self-limited manifestation of multiple cortical hyperostoses accompanied with a moderate leukocytosis with temperature rise some-time during the acute phase. Usually more than one area of the body was involved. The family and maternal histories were all non-contributory. The pregnancies were normal with no history of any unusual complication at the time of birth. The x-ray findings were quite consistent. They usually showed definite periosteal proliferation, marked soft tissue swelling and later irregular new bone formation. It is very interesting to note in Case i that periostitis involving the right ulna and the right humerus developed during the patients stay in the hospital. (Figs. ia, ib and ic.) In Case n the x-ray findings are very instructive, correlating closely with the patients clinical course. As the patients symptoms decreased, the x-ray findings also showed definite improvement. Laboratory studies were of significance only in ruling out other known diseases. All serologie tests for syphilis were negative. In the differential diagnosis syphilis, trauma, scurvy, infection and neoplasm should be considered but the characteristic features of the syndrome, infantile cortical hyperostosis, appear to be distinct from any of these. To date no etiologic factor has been proven as causing the condition. Caffey and Silverman 2 suggest the possibility of this syndrome being a subperiosteal allergic edema. To consider that this temporary osseous response resembles those cases with temporary soft tissue edema as in angioneurotic edema is an interesting concept and one that is worthy of further consideration. Also, there may be a disturbance of the normal immunity which the infant possesses during the first year of life permitting the development of these osseous changes. It is curious that this clinical entity has not been found reported before Caffeys 1 original article in 1939, for in both orthopedic and pediatrie practice the syndrome must have been previously observed.

The differential diagnosis of the “painful hip” in childhood

T HIS titIe is chosen in order that the differential diagnosis of such a vague term as “painfur hip” may be reviewed. The term is not to be regarded as a diagnosis in any way but merely as a symptom. Formerly a11 children with the complaint of pain in the hip were rather IooseIy diagnosed as “tuberculosis of the hip,” but with more thorough history taking and examining acumen, aided by roentgenograms and Iaboratory data, other conditions have been reveaIed and we should Iike to review some of them. For convenience of discussion we have divided the patients with compIaint of pain in the hip into three general groups: those of inffammatory origin, those of traumatic origin and the epiphyseal disturbances.

The Evolution of Physiological Concepts in Bone Surgery

An orthopaedic surgeons may well be proud of the great privilege of being your President. As our group represemsts the oldest active national orthopaedic associations ins the Ensglish-speakinsg world, this honor, as one Past Presidenst so wisely wrote rise, “ will nssake you prouti, happy, Isunible, arid insspire(1 all at one t.insse”-although I dloul)t the hat ten’ quality has beers achieved. It has beers a nsienssorable year ins the life of your President, arsd he would like to express to you his nisansy thanks for the friendly letters arid messages received! by him. Nee!less to say the duties have beers made pleasant amid the respomssil)ilit.ies lessened! by the unfailing efforts of your officers arid! comnsittee chairmen amid of your insdefatigable secretary, to all of whom I ow’e a vote of sinscere thansks. For somsie years your Presidemst has felt the desire amid hope that. someone ins The Associatioss would have the temerity to niake a plea for i)etter physiological concepts ins 1)one surgery. Today I w’ould like to try to discuss this subject, which ins the past few’ years has been increasingly ins my thoughts. I know’ that we all see the need in our daily pr’act.ice for better physiological comscept.s regarding horse surgery. I know that we all try to keep consstanstly ins minid basic principles svhens repairing horses. The rigid fransew’ork of our body supplies strensgth arid! support.. Yet, our surgical techniques must be based! on soursd physiological grounds arsd i)onie must riot be thought of as an imiansinisate, rigid type of substans(’e ins which sini)st.itut.ionss cans freely be nsade for misissinig or poorly functioning I)arts. \Ve nisust riot lose sight of the lessons the past cats teach us, for’ to be tnnsfanssilian’ ivithi the past may n’esult ins a duplications of effort awl mseedless surgery for’ the patienst. It is always helpful arid instructive to browse among books that n’eveal the thoughts of the great masters of our specialty ins their indefatigable search for insfornsations reganiinsg the phenomena of tissue growth amid repair as illustrated in horse surgery. ‘l’he accunisulations of knsowledge is at best a slow’ process requiring both experience amid observations. Tod!ay basic investigations of the osseous system have possibly lagged behind the study of issansy of the other systems, due to the lack of zeal ons the part of those niost instimately concerned, the orthopaedic surgeons. Regarding the importance of inivestigations, it may i)e of insterest to quote frons the third Americans Orthopaedic Asso(’iations presidential address by I)r’. E. G. Brackett ins 1899. He wrote, “ Imivestigations is especially nseeded as w’ell as the careful collections of recorded facts ansdl results “ ; nssore than half a censtury later, we are seeing the fulfilimenit of this goal through the isewly organized Orthopaedic Research Society arid its financial ally, the Orthopaedic Research amid Educations Founsdat.ions. These two organizations should succeed in establishing orthopaedic surgery on a more scientific foundation, and we believe in amid foresee their growth and contributions as vital factors in our specialty. Let us also remember that medical advances are frequently made through ancillary contributions amid by mson-medical as well as medical observers, so that. it hehooves each of us to keep in contact with investigators in related fields. The broad scope of the membership eligibility in the newly organized Orthopaedic Research Society should be of great educational value to the specialty of orthopaedic surgery ; it is felt that the work of this Society will help to prove the truth of the statement that “ progress is our most important product”. The early foundinsg of our Associations ins 1887 amid the consistency with which sciens-

Infections of the tendon sheaths

Abstract Acute infections of the tendon sheaths most frequently involve the fingers and hand, and due to the anatomic arrangement of these sheaths rapid spread of the infection may be expected. Early adequate surgery along the areas of election shown in the diagram offer the best opportunity for the return of function.