The Region of the Knee Joint. 363 



gins should, therefore, be respected. After the division 

 of the bones, the diseased synovial membrane is removed, 

 the ligamentum patellae united, the wound sutured and the 

 limb fixed in a suitable splint. 



Amputation. Amputation in the neighborhood of 

 the knee joint may be done immediately above the base of 

 the condyles, by Garden's, or by some modification of Car- 

 den's method. In Garden's operation, an incision starts over 

 the most prominent part of the tuberosity of one condyle, 

 and sweeps with an easy curve, across the anterior aspect of 

 the limb, crossing the median line, about the middle of 

 the patellar ligament, while the posterior incision is quite 

 horizontal. The tendon of the quadriceps is then divided 

 above the patella, which is removed, and the femur is 

 sawn through at the desired point. Faraboeuf's modifica- 

 tion consists in making the anterior flap about one inch 

 longer than the antero-posterior diameter of the limb at 

 the saw line, while the posterior is equal to half that dia- 

 meter. The steps are otherwise the same as in Garden's 

 method. It is much more advisable, however, to disar- 

 ticulate at the knee joint rather than saw through the 

 femur, and for disarticulation at the knee joint, Stephen 

 Smith's method is usually employed. In this, an incision 

 commences in front, in the median line, about one inch be- 

 low the tubercle of the tibia, and is carried, in a curved 

 manner, across the most prominent part of the outer side 

 of the leg. It then slopes upward to reach the middle line 

 at the posterior aspect of the limb. A second incision be- 

 gins at the same point in front and is carried in a similar 

 manner across the inner side of the leg to meet the first in- 

 cision on the posterior aspect. The inner flap should be a 

 little longer than the outer, so as to provide for the longer 



