The Classic: On the Means of Lengthening, in the Lower Limbs, the Muscles and Tissues Which are Shortened Through Deformity

The difficulties to be encountered in lengthening a shortened limb, are found, in operation, to be greater as regards the fleshy parts, than as regards the bones. It is comparatively easy to remove the splinters of a fractured bone which is wrongly consolidated; to separate a curved bone; or to perform an oblique osteotomy, but a decided limit is arrived at in the correction of a displacement, or in the lengthening of the bones, by reason of the contraction, or resistance, of the muscles. Our supreme consideration must therefore be given in striving to overcome this resistance on the part of the muscles, without however damaging in any way the action of the tissues. This is the special subject on which I desire to enlarge, as it appears to me that this important part in the cure of deformity of the limbs, has never been sufficiently taken into consideration. As things stand at present, we trust to empiric measures to overcome this contraction of the muscles, whereas in reality mathematical precision should be used, in each special case. But for this mathematical precision, we are still in want of a scientific basis. We are in fact, without the requisite knowledge as to how the normal muscles and other tissues act, when subjected to forced distention; as to how great an extent they are capable of being lengthened, without their physiologic action being altered; as to the method, in lengthening, which may be best adapted to them; as to the action, while subjected to distention of those tissues which have become shortened through the separation of the bone which kept them in place; as to their loss in elasticity, when time has elapsed since their shortening, and as to many other questions, which I omit, for the sake of brevity. In consulting works on the subject, we find that surgeons have adopted very diverse courses in cases of lengthening the fleshy parts, where there is shortening of the limbs. The greater number have applied constant traction, after having separated the bone; others have used great stretching, under narcotics, followed by constant extension of the muscles, by means of weights; others again, after the stretching, have applied the plaster apparatus. A very notable difference exists also as regards the degree of force which has been applied with the weights, ranging from a small, to a high number of kilogrammes, without a proportionate difference existing in the condition of the resistance of the muscles, in relative cases. The treatment by the surgeon of these cases has been determined rather by matter of habit, than by the exigencies required, as scientifically proved, in each individual case, and each operator has had recourse, for instance, either to