1. Both with adults and children in poor economic conditions, with no pulmonary contra-indication, resect joint as soon as a positive diagnosis is made.
2. In adults, during the early stage, with good economic conditions, conservative treatment (splint or cast) may be used as long as there seems to be no progression of the disease. (Even here, we are inclined to advise resection as soon as diagnosis is made.) In children, in the early stage, with economic and home conditions good, the conservative treatment should be given a trial. Should there be no improvement after nine months or a year, or should progression of the disease be evident, resection is to be advised, provided there is no pulmonary contra-indication.
3. In adults, with general condition poor, or with incipient pulmonary tubercular process, amputate above the knee.
4. In children, in poor general condition or with incipient pulmonary tubercular process, conservative treatment should be attempted for about six months. Should the general condition not improve, amputation should be advised.
5. When the general condition of the patient is good, the presence of a sinus from the joint is not a contra-indication for resection of the joint. It is realized that this is a radical step, and not without danger, but under good operative conditions, it may be attempted in order to save the patient time, and, considering conditions in this country, to save bed space. This is advised with the consideration that conservative treatment gives no sure hope that the sinus will heal, and also in consideration of the fact that, should it heal, resection would be indicated.
6. The mortising of the two bones is the operative choice.
7. The joining of the two bones together by bone plates gives a quicker bony union than uniting the bones with kangaroo sutures passed through holes upon the two sides of the leg.
(C) 1923 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.