- [The Lower Extremity]:
- [Congenital dislocation of hip]
- —[Snapping hip]
- —[Paralytic deformities]
- —[Contracture and ankylosis of hip]
- —[Coxa vara and coxa valga]
- —[Congenital dislocation of knee and patella]
- —[Genu recurvatum]
- —[Paralytic deformities]
- —[Contracture and ankylosis of knee]
- —[Genu valgum and genu varum]
- —[Congenital deformities of leg]
- —[Bow-leg]
- —[Club-foot]:
- [Talipes equino-varus];
- [Pes equinus];
- [Pes calcaneus];
- [Pes calcaneo-valgus] and [varus];
- [Pes cavus];
- [Flat-foot and pes valgus]
- —[Painful affections of heel]
- —[Metatarsalgia]
- —[Hallux valgus and bunion]
- —[Hallux varus]
- —[Hallux rigidus and flexus]
- —[Hammer-toe]
- —[Hypertrophy of toes]
- —[Supernumerary toes]
- —[Webbed toes].
- [The Upper Extremity]:
- [Congenital absence of clavicle]
- —[Elevation of scapula]
- —[Winged scapula]
- —[Congenital paralytic deformities of shoulder]
- —[Deformities of elbow]
- —[Club-hand]
- —[Deformities of wrist]
- —[Madelung's deformity]
- —[Deformities of fingers]
- —[Dupuytren's contraction]
- —[Polydactylism].
The surgery of the extremities is so largely concerned with the correction of deformities that it is necessary at the outset to refer briefly to some points relating to the time and mode of origin of these.
1. Congenital deformities—that is, those which originate in utero and are present at birth—are comparatively common and may be due to a variety of causes. Some result from errors of development—for example, supernumerary fingers or toes, and deficiencies in the bones of the leg or forearm. A larger number are to be attributed to a persistent abnormal attitude of the fœtus, usually associated with want of room in the uterus—for example, the common form of club-foot and congenital dislocation of the hip. Less frequently amniotic bands so constrict the digits or the limbs as to produce distortion, or even to sever the distal part—intra-uterine amputation. Lastly, certain diseases of the fœtus, and particularly such as affect the skeleton—for example, achondroplasia—cause congenital deformities.
2. Deformities originating during birth are all traceable to the effects of injuries sustained in the course of a difficult labour. Examples of these are: wry-neck resulting from rupture of the sterno-mastoid; lesions of the shoulder-joint and brachial plexus due to hyper-extension of the arm; a spastic condition of the lower limbs—Little's disease—resulting from tearing of blood vessels on the surface of the brain with hæmorrhage and interference with the function of the cortical motor area.
3. Deformities acquired after birth arise from widely different causes, of which diseases of bone, including rickets, diseases of joints, and affections of the nervous system attended with paralysis, are amongst the commonest. Other deformities are produced by unsuitable clothing, such as a tight corset, or ill-fitting shoes distorting the toes, prolonged standing in growing subjects overstraining the mechanism of the foot and giving rise to the common form of flat-foot.
The part played by the palsies of children in the surgical affections of the extremities necessitates a short description of their more important features.
Anterior poliomyelitis is the lesion underlying what was formerly known as infantile paralysis—a name to be avoided, because the condition is not confined to infants and it is not the only form of paralysis met with in young children. Anterior poliomyelitis is characterised by an illness attended with fever, in which the child is found to have lost the power of one, less frequently of both lower extremities; or, it may be, of one or both arms. After a period, varying from six weeks to three months, the paralysis tends to diminish both in extent and degree, and in the majority of cases it ultimately persists only in certain muscles or groups of muscles. At the onset of the paralysis the affected limb is helpless and relaxed, the reflexes are lost, the muscles waste, and those that are paralysed exhibit the reaction of degeneration. In severe cases, and especially if proper treatment is neglected, the nutrition of the limb is profoundly affected; its temperature is subnormal, the skin is bluish in cold weather and readily becomes the seat of pressure sores. In course of time the limb lags behind its fellow in growth, and tends to assume a deformed attitude, which at first can easily be corrected, but later becomes permanent.
