This operation is of no great use, because, on account of the position of the joint and the arrangement of the articular surfaces, the end of the second phalanx extends beyond the line of section. To avoid complications, therefore, it is better to remove the lower extremity of the second phalanx, which, moreover, is always injured to a greater or less extent in cases of pedal arthritis. To effect this it is only necessary to draw back the flap of skin a little and rapidly divide the second phalange at its upper third with a fine saw. The points of section of the tendons and ligaments must be carefully examined, and if they exhibit necrosis should be further shortened.
The stump is enveloped in a surgical dressing fixed to the pastern.
Amputation of the two First Phalanges.—When necrosis is very serious and has extended a long way upwards, it is often better immediately to resort to amputation of the two last phalanges.
The region is first shaved and thoroughly cleansed. The coronary band of the claw is also preserved in this case.
First stage. The horn below the coronary band is thoroughly thinned and the tissues are divided as far as the bone.
Second stage. The skin covering the front of the limb is vertically incised from the lower third of the first phalanx (Fig. 298) to the coronary band; the skin is separated and external and internal flaps are formed.
Third stage. The extensor pedis tendon is divided, the first inter-phalangeal joint opened, the internal and external lateral ligaments are divided, the claw is pressed backwards, and the flexor tendons are also divided.
To facilitate disarticulation, and particularly to facilitate section of the lateral ligaments, the claw is rotated successively outwards and inwards.
According to circumstances, the lower extremity of the first phalange is either scraped or divided and the stumps of the tendons are carefully trimmed to a regular shape.
A surgical antiseptic dressing is applied over the whole of the seat of operation.