Introduction: General surgical technique of operations on the limbs of paraplegics.- Anaesthesia.- a) Details.- b) Typical anaesthesia.- Neurological terminology.- The level of paraplegia.- Complete and incomplete paraplegia.- Spastic paraplegia.- Flaccid paraplegia.- Paralysis of autonomic mechanisms.- General statistics, Tables 1–7.- A. Operations for spasticity and contractures.- Prevention of contractures.- The right time for an operation.- The right type of operation.- Multiple operations.- The intrathecal alcohol block.- Operations for spasticity and contracture: General statistics, Tables 8–9.- Common-operations.- 1. Obturator neurectomy for spastic adduction-contracture at the hip (after Selig 1914) (Tables 10–12; Figg. 1,2).- a) Technique of the operation.- b) Postoperative treatment.- c) Complications and mistakes.- Summary.- 2. Iliopsoas myotomy for spastic flexion-contracture at the hip (Tables 13,14; Figg. 3–5).- a) Technique of the operation.- b) Postoperative treatment.- c) Complications and mistakes.- Summary.- 3. Tenomyotomy of the superficial flexors of the knee for spastic flexion-contracture (Tables 15–17; Figg. 6, 7).- a) Technique of the operation.- b) Postoperative treatment.- c) Complications and mistakes.- Summary.- 4. Elongation of the Achilles tendon for spastic pes equinus (Tables 18–20; Figg. 8,9).- a) Technique of the operation.- b) Postoperative treatment.- c) Complications and mistakes.- Summary.- Rare Operations.- 5. Open tenotomy of the tibialis posterior tendon.- 6. Tendon-transfer at the ankle.- a) Bilateral severely spastic pes equino-varus (Figg. 10,11).- b) Unilateral severely spastic pes equino-varus (Figg. 12–14).- c) Spastic pes equino-valgus.- 7. Neurotomy of the peroneal nerve.- 8. Subcutaneous tenotomies and corrections of spastic toes.- 9. Operations for flaccid limitation of extension at the hip.- 10. Cases.- Case I. Severe spastic flexion-contracture of the knee (Figg. 15, 16).- Case II. Severe flaccid flexion-contracture of both knee joints (Fig. 17).- Case III. Severe flaccid extension-contracture of the knee joints.- Case IV. Severe adduction and flexion-contracture of the hip with fixed subluxation (Fig. 18).- B. Arthroplasty for extension-ankylosis of the knee joint (Table 21; Figg. 19–21).- a) Indication.- b) Technique of the operation.- c) Postoperative treatment.- Summary.- C. Operations for para-articular ectopic ossification (Tables 22, 23; Figg. 22–24).- Pathology.- Methods of operation.- 1. Para-articular Pseudarthrosis.- a) Technique of the operation.- 2. Excision of the ectopic bone.- a) Technique of the operation.- b) Postoperative treatment.- Summary.- D. Operation for septic arthritis of the hip joint (Tables 24–26; Figg. 25–27).- Pathology.- a) Technique of the operation.- b) Postoperative treatment.- c) Complications and failures.- Summary.- E. Fractures of the long bones.- 1. Associated fractures of the long bones (Tables 27, 28; Figg. 28–35).- Priorities.- Conservative treatment.- Fracture-healing and spasticity.- Case V. Conservative treatment of threatened non-union of nailed femur.- Operative treatment.- a) Upper extremity: Early operations: Indications.- Case VI. Early open reduction and plating of the shaft of the humerus, in a case with radial palsy.- Case VII. Early open reduction and plating of the comminuted shaft of the humerus, combined with plexus-paralysis,..- Fractures of the forearm: Indications.- b) Upper extremity: Late operations: Indications.- Case VIII. Fracture of lower third of ulna combined with fracture-dislocation of T 8/9 vertebra, incomplete paraplegia and haemothorax, mediastinal tear and brain injury.- Case IX. Fracture of both bones of the forearm on one side and of the ulna on the other side, combined with fracture-dislocation of C. 5/6, complete quadriplegia below C. 6 and haemothorax.- c) Lower extremity: Late operations: Indications.- Case X. Supracondylar fracture of femur. Limitation of knee-flexion (Figg. 29,30).- Case XI. Comminuted fracture of tibial condyles. Limitation of knee-flexion (Fig. 31).- Case XII. Pseudarthrosis of femur. Plating and sliding graft (Figg. 32, 33).- Case XIII. Pseudarthrosis of the tibia. Sliding graft (Figg. 34, 35).- Summary.- 2. Late fractures: Indications.- Case XIV. Fracture of the proximal third of femur with severe spasticity 45 Case XV. Fracture of the neck of femur in a young man with a very incomplete cauda-equina lesion below L 4.- Small operative measures.- Summary.- F. Upper limb.- Tendon-transfers and arthrodesis of the wrist (Table 29; Figg. 36–38).- Indications.- Case XVI. Reconstruction of extensor carpi radialis (Fig. 36).- Tendon-transfers: Operative technique (Fig.37).- Case XVII. Arthrodesis of the wrist in a quadriplegic, complete below C. 4/5 (Fig. 38).- Summary.- G. Amputation.- Literature.
