OSTEOTOMY FOR BOW-LEGS. 
BY 
W. H. CARMALT, M. D., 
PROFESSOR OF SURGERY IN YALE COLLEGE, NEW HAVEN, CONNECTICUT. 
FROM / 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
January, 1884. Extracted from the 
American Journal of the Medical Sciences for January, 1884. 
OSTEOTOMY FOR BOW-LEGS. 
By W. H. CARMALT, M.D., 
Professor of Surgery in Yale College, New Haven, Connecticut. 
Lizzie Doty, aged 5 years, was admitted to the New Haven Hospital 
on April 8, 1882, with extreme curvatures outwards of the tibiae and 
fibulae of both legs, somewhat more marked in the left than in the right. 
The child was well nourished, in face and chest almost robust; except 
for slight epiphyseal enlargements at the carpo-radial articulations, there 
was no other deformity than those associated with the bow-legs. Each 
femur had a well-marked anterior curve, but no lateral; the condyles were 
all on the same horizontal plane, and a straight line drawn from the 
centres of the patellaa to the apices of their corresponding great trochan- 
ters passed as nearly as might be along the median lines of the femorae. 
On applying the internal condyles together, the legs below the knees 
crossed in the manner represented in Fig. 1, in which the external side 
Fig. I- 
Fte. 2. 
of each foot to the ankle was, when the child was held in the erect posi- 
tion (for she was quite unable to stand so), applied to the floor. Bringing 
the ankles together the knees were widely separated, and in resting the 
foot flat upon the floor, quite an angle was made laterally with the leg 
(Fig. 2). This angle was principally due to a bend in the tibia and 2 
fibula just above the ankle-joint, but it was also evident that the main 
curvatures were in the upper part of the legs just below the tuberosities of 
the tibiae. The child could not balance herself in this position with the 
feet close together, but required some external support. When allowed to 
stand alone the position taken was with the feet straddled widely apart, so 
that in walking she swayed from side to side with a most ungainly waddle; 
she could walk but a short distance. On April 24, with the assistance of 
Dr. Chas. T. Poore, of New York, to whose kind advice much of the 
good result of this case is due, I divided by separate incisions both tibiae 
and both fibulas at points about one inch and one and one-half inch respec- 
tively below the level of the tubercles of the tibiae, using Macewen's 
chisels with a mallet in making the sections of the bones. During the 
operations the wounds in the skin were kept irrigated with a two and a 
half per cent, solution of carbolic acid. After the fractures were accom- 
plished the legs were brought into as nearly a straight line with the 
femurs as possible, all coagula were carefully pressed out of the wounds, 
and the latter closed by borated cotton and strips of adhesive plaster ; 
plaster of Paris splints from knees to ankles were put on, with the legs 
as straight as possible, and the two limbs were fastened together. 
The morning after the operation the temperature was 99°, the child 
was restless, but did not complain of pain ; on the second day fenestras 
were cut in the bandages opposite to the wounds, no discharge was found 
on the cotton, but one external wound, that over the left tibia, was not 
united. On the afternoon of the fourth day after the operation the tem- 
perature arose to 99.8°, remained so the next morning, but fell to 98.2° 
in that afternoon, and never rose above 99° again during her stay in the 
hospital. 
There was never any suppuration from the track of the wound ; the 
splints were removed on May 28, just one month from the operation, 
because of some excoriations of the skin at the edges of the fenestrae. 
The union of the bones was quite firm, the curvatures (angularities) at 
the upper part of the legs were quite removed, those at the lower part 
being, of course, still uncorrected. The lateral ligaments of the knee- 
joint had been so stretched, from the manner in 
which formerly the weight of the body had borne 
upon them, that the joint had quite a perceptible 
lateral movement; the patient was, therefore, not 
allowed to walk, the legs were kept straight by 
being tied together for several weeks longer. She 
was then allowed to walk with a pair of shoes with 
braces reaching on each side of the limb to about 
half w'ay up the thigh, with fore and aft hinge- 
joints at knee and ankle. Locomotion, however, 
was still quite awkward, but she was allowed to 
go home to return for further treatment, which 
she did on November 25, and on December 17 
osteotomy was again performed on all four bones 
at one sitting at points about three inches above 
the malleoli, and under the same precautions as 
to sepsis as before, except that the wounds and 
legs were afterwards dressed in carbolized cheese 
cloth. The legs were firmly bound together, after 
being straightened with a compress of uniform 
thickness between them, so that they wrere parallel 
from ankles to knees. 
Fig. 3. 3 
The temperature did not rise above normal until the afternoon of the 
second day, when it reached 98.9°, which point it also reached the next 
afternoon ; after that it fell and never rose above 98.4° again. On the 
third day after the operation the carbolized dressings were removed as a 
slight carbolic eczema had been excited and borated cotton was substituted. 
On December 24, the external wounds having quite healed, the legs were 
put up in plaster of Paris splints. On January 27 these were removed, 
and the legs bandaged together with a straight, short splint between them 
reaching to the knees. On February 17 the splints were removed and 
the shoes with braces put on ; she walked fairly well, but from long habit 
separated the feet widely, and did not bend her knees much. She im- 
proved in this respect, however, and at this date, August 13, 1883, one 
would hardly remark that there had been any deformity. The photo- 
graph of Fig. 3 was taken on February 24, the date of her removal from 
the hospital. DR. A. E. FOOTE 
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