REPORT OF A CASE 
OF 
RIGHT-ANGLED DEFORMITY OF KNEE, 
RESULTING FROM 
TUBERCULAR ARTHRITIS. 
BY 
JAMES F. E. COLGAN, A.M., M.D., 
Clinical Assistant Orthopredic Department Jefferson Medical College 
Hospital. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, NOVEMBER 15, 18Q2. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1892. Report of a Case of Right-Angled 
Deformity of Knee, resulting 
from Tubercular Arthritis. 
MRS. F. S., aged 22, presented herself at 
the Orthopsedic Department of the 
Jefferson Medical College Hospital, April 27, 
1892, complaining of a stiff knee. On exam- 
ination it was found that the leg was flexed at 
an angle of ninety degrees, and was partially 
anchylosed. 
From the patient the following history was 
obtained : Father has phthisis and is of a 
rheumatic diathesis. The history of her 
mother is indefinite ; she died in childbirth. 
A cousin has coxalgia. 
The patient first noticed the trouble in 
January, 1892, when she observed that the 
knee was a little enlarged ; there was not 
much pain at first. The swelling increased 
in size, causing her to go to bed, where she 
remained for three months, the pain being 
severe all this time. During the entire time 
the patient was in bed the knee was main- 
tained in a comfortable position by support- 
ing it upon pillows in a right-angled position. 
When she arose from her bed the knee was 
in the partially anchylosed condition as when 
she appeared at the hospital. This case, like the great majority of chronic 
joint affections, occurs in a patient with a dis- 
tinct tubercular family history. The father 
and a cousin are sufferers from tubercle, 
while the history of the mother is very indefi- 
nite. 
When the patient came to the hospital 
there was a slightly enlarged knee-joint, tem- 
perature was normal, the patella was firmly ad- 
herent to the external condyle of the femur. 
There was an undue contraction of the semi- 
membranosus, semi-tendinosus, and the bi- 
ceps. The very slight motion present was 
that which was permitted by the ligamentum 
patellae. Flexion and extension terminated 
by a sudden checking; further extension 
was prevented by the tibia striking against 
the immovable patella, while flexion was ter- 
minated by the ligamentum patellae becoming 
fully extended. 
The history of the case indicates that there 
had been a tubercular synovitis, which after 
the tubercular matter was absorbed, caused 
an agglutination of the surfaces of patella 
and femur. 
Several attempts were made to break up 
the adhesions by passive motion and forcible 
manipulation, but without avail. As the pa- 
tient was adverse to an operation, in the 
early part of April, 1892, Dr. W. J. Hearn at- 
tempted to free the patella by means of sudden 
blows of a mallet. As this was unsuccessful, it 
was determined to lay the joint open, which 
was accordingly done, May 5, 1892. 
Professor H. Augustus Wilson made an in- 
cision on the external aspect of the knee ; 
through this opening the constricting bands uniting the tibia and femur were loosened. 
The patella was freed from its calcareous at- 
tachment to the condyle of the femur by means 
of an osteotome, and the limb was placed in a 
straight extended position. The wound having 
been thoroughly cleansed, and. drainage by 
strands of catgut being provided for, the lips 
of the incision were brought together with 
sutures, and an antiseptic dressing was applied. 
A plaster-of-Paris dressing was applied to the 
limb, in order to keep the leg in the corrected 
position. 
The plaster-of-Paris dressing was made in 
two sections, one of which enveloped the foot 
and leg, the other the thigh. Hooped pieces 
of iron, retained in position by layers of 
plaster-of-Paris bandages, connected the two 
sections, allowing access to the wound with- 
out disturbing the position of the knee. 
There was primary union of the wound. 
Sutures were removed May n. She left the 
hospital May 31, a new plaster-of-Paris dress- 
ing being then applied. 
The patient reported at the hospital, June 
11, 1892. The part was perfectly well ; there 
was no discharge from the wound ; the limb 
was in the corrected position,—i.e., leg in a 
straight line with the thigh. She used crutches, 
and a light plaster-of-Paris dressing ensheathed 
the whole limb. 
On July 15 the plaster-of-Paris dressing 
was abandoned, and no additional support 
was found necessary. The patient walked 
without crutches, with a freedom that de- 
noted an entire absence from pain or incon- 
venience other than a stiff knee. JANUARY 15, 1893. 
WHOLE SERIES, VOL. PCV(1, 
THIRD SERIES, VOL. JX.; 
■TH E 
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Surgical >m gcnito-Urinarv therapeutics. 
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