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It must first be decided that the ankylosis is fibrous, and these suggestions are only applicable to such cases as are distinctly of that character. If inflammation is present to any great degree in or about the joint, the operation is contra-indicated; but there are very few cases which do not exhibit some slight existing sub-acute inflammatory state in some parts of the osseo-ligamentous structures constituting the joint. This is sometimes sufficient to give rise to reflex contractions of the muscles governing the joint, and one authority states that the indication for dividing the tendons of these muscles, as an adjunct to the operation of brismé forcé, is the reflex spasm exhibited when the tendons are pressed upon.
There are not many cases, however, where tenotomy is really necessary, if the muscular contraction be merely reflex, and not due to actual shortening of the muscular structure. It may be subdued
STILLMAN CF. SUGGESTIONS ON THE MANAGEMENT OF BRISME FORCE OF THE KNEE.. JAMA. 1884;II(8):203–204. doi:10.1001/jama.1884.02390330007001b
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