240 



Dr. W. Macewen. 



[May 19, 



was conical, tapering from the head to a narrow spike-like distal 

 extremity, which appeared, when he attempted to raise the arm, as if it 

 would penetrate the skin. From this down to the condyles there was 

 a complete absence of bone, there being nothing bat soft tissues in the 

 gap. The muscular power was good, but when he attempted to raise 

 his arm a contraction of the muscles took place, the condyles being 

 drawn towards the proximal extremity, while some fibres of the 

 deltoid raised the spike-like process of the upper portion, causing it to 

 project as if about to penetrate the skin. Here the action ceased,, 

 the soft parts in the gap appearing like a rope during the contraction- 

 He could not raise his forearm to his breast. If one caught the arm 

 firmly with the hand so as to keep the condyles fixed and separate 

 from the upper fragment, then the patient could elevate the forearm 

 towards his chin. The power was there ; the lever and fulcrum were 

 wanting. An apparatus supplying these might have been devised, but, if 

 such an expensive article could have been obtained, it would have 

 been necessary to renew it often as he grew older. On account of his 

 social condition it would have been impossible to secure this and the 

 after attention necessary. The only other alternative was to supply 

 the gap by transplantation of bone. 



In my wards there were numerous cases of marked anterior tibial 

 curves, from which wedges of bone had to be removed, and it was- 

 determined to utilise these wedges as transplants. 



Transplantations of Bones. 



Transplantation of hvo Wedges of Bone. — On November 9th, 1879' 

 (one year and three months after the removal of the necrosed shaft) 

 an incision was made down to the extremity of the upper fragment.. 

 This extremity was found to be cartilaginous for fully a quarter of an 

 inch. This cartilaginous spike-like process was removed, leaving then 

 a portion of bone which measured If inch from the tip of the acromion 

 process. From this point a sulcus about 2 inches in length was made 

 in a downward direction between the muscles. The former presence 

 of bone was nowhere indicated, and the sole guide as to the correct 

 position into which the transplant was to be placed was an anatomical 

 one. After the sulcus was formed, the haemorrhage was fully arrested,, 

 and an aseptic sponge was placed in the gap, which was then ready to 

 receive the bone. 



Two wedges were then removed from the tibiae of a patient six years 

 of age, affected with anterior tibial curves. The base of these osseous 

 wedges consisted of the anterior portion of the tibia, along with its- 

 periosteum, the wedges gradually tapering towards the posterior part 

 of the tibee. 



They were removed, then cut into small fragments with the chisel, 

 and immediately thereafter they were deposited in the sulcus in the 



