Gritti’s osteoplastic supracondyloid knee amputation, patella utilized: a, shaded parts are those brought in apposition; b, appearance of Gritti stump after suture; c, correct apposition of patella to femur; d, defective apposition. (Farabeuf.)
[Fig. 712] will best illustrate the intent of the method as well as its performance. The incisions are planned much as in the Stephen Smith disarticulation method, only they are placed higher, and the patellar tendon is divided as low down as possible, or even separated from the tibia, in order that it may be made of use in attaching the divided patellar surface to the femoral end. The rest of the operation is performed as by other methods, the attachment of the patella being effected by tendon sutures, or, if necessary, by an ivory peg, or even a metal tack or nail which may be left in place.
The beauty of this method is that the anterior surface of the patella is preserved with its natural weight-bearing facilities and the bursa between it and the skin, while the latter is undisturbed. On the end of this stump as much weight can be steadily borne as when one ordinarily kneels, and to it a most serviceable kind of artificial limb can be attached, with which one may walk as though nothing had ever happened.
Another osteoplastic method, namely, that of Sabanejeff, is illustrated in [Figs. 713] and [714]. In this instance the bone covering over the end of the femur is taken from the upper end of the tibia, the patella not being disturbed. It permits a lower division of the femur and the formation of a stump which is of practically the same length as the original thigh.
Fig. 713
Sabanejeff’s knee amputation. (Chalot.)
Fig. 714
