THE ARTICULATIONS, OR JOINTS 



ward and inward. It is often said that the deformity is produced by undue length of the inner 

 condyle, but in reality the condyle grows as the deformity progresses. 



Excision of the knee-joint is most frequently required for tuberculous disease of this articulation, 

 but is also practised in cases of disorganization of the knee after rheumatic fever, pyemia, etc., 

 in osteoarthritis, and in ankylosis. It is also occasionally called for in cases of injury, gun- 

 shot or otherwise. The operation is best performed either by a horseshoe incision, starting from 

 one condyle, descending as low as the tubercle of the tibia, where it crosses the leg, and is then 



carried upward to the other condyle; or by 

 a transverse incision across the patella. 

 In this latter incision the patella is either 

 removed or sawed across, and the halves 

 subsequently sutured together. The bones 

 having been cleared, and in those cases 

 where the operation is performed for 

 tuberculous disease all pulpy tissue hav- 

 ing been carefully removed, the section 

 of the femur is first made. This should 

 never include, in children, more than, at 

 the most, two-thirds of the articular sur- 

 face, otherwise the epiphyseal cartilage 

 will be involved, with disastrous results 

 as regards the growth of the limb. After- 

 ward a thin slice should be removed from 

 the upper end of the tibia, not more than 

 half an inch. If any diseased tissue still 

 appears to be left in the bones, it should 

 be removed with the gouge rather than 

 by making a further section of the bones. 



III. The Tibiofibular Articulation 

 ( Articulatio Tibiofibularis) . 



TUBCROSITY 

 "OF TIBIA 



The articulations 

 tibia and fibula 



are 



INNER 

 MALLEOLUS 



OUTER 

 MALLEOLUS 



ANTERIOR LIGAMENT 

 OF LATERAL 

 MALLEOLUS 



FIG. 273. Ligaments of the right leg, from in front. 

 (Spalteholz.) 



between the 

 effected by 

 ligaments which connect both ex- 

 tremities, as well as the shafts of 

 the bones. It may, consequently, be 

 subdivided into three articulations: 

 (1) The superior tibiofibular articu- 

 lation. (2) The middle tibiofibular 

 ligament or interosseous membrane. 

 (3) The inferior tibiofibular articu- 

 lation. 



1. THE SUPERIOR TIBIOFIBULAR 



ARTICULATION (ARTICULATIO 



TIBIOFIBULARIS). 



This articulation is an arthrodial 

 joint. The contiguous surfaces of 

 the bones present two flat, oval 

 facets covered with cartilage, and 

 are interconnected by the following 

 ligaments: 



Capsular. 



Anterior Superior Tibiofibular. 



Posterior Superior Tibiofibular. 



