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Patient 83/67
Prior to his admission to Stannington this boy had been treated in the Royal Victoria Infirmary (RVI), Newcastle-upon-Tyne, for pleurisy and TB of the knee for over 18 months. Within the transfer notes from the RVI it was noted that previous treatment for his knee had included 'extension and plaster' and that some limb wasting and shortening had been noticed. On admission to Stannington an initial examination revealed:
"Induration of the L. thigh. Knee large with swelling. 3 sinuses discharging on outer side of thigh some on med (inner) side of tibia."
This corresponded with the x-ray report that stated that there was advanced disease in the knee with a focus in the proximal tibia and destruction to the epiphyses.
Throughout the following 3 years this patient shows a slow but steady improvement. X-ray reports note a maintained improvement with a reduction in the swelling and no sequestrum, but state the joint has been badly destroyed and that the tibial shaft has also become involved. A pattern of persistently discharging sinuses is noted throughout the medical notes, whereby different sinuses are considered very or slightly active at various times. In contrast to the x-ray report, however, one comment made in October 1939 stated "sinus not yet healed sequestrum being discharged" suggesting fragmentary bone being present in the discharge from the sinuses.
Prior to 1939 the medical notes mention little about treatment for this patient, but, in June 1939 he is provided with a knee splint, crutches and a patten. With the aid of the splint the patient is noted to be walking well although the sinuses surrounding the knee remain active. However, further destruction is noted to have taken place to the tibia in September 1939 and a small cavity is present in the upper tibia in February 1940. By July 1940 healing is noted to have begun with sinuses considered nil active and the tuberculosis in quiescence. His final x-ray report reads:
"Knee disease looks quiescent. Much destruction of epiphyses of tibia and involvement of shaft. Will require strengthening later."
This boy was discharged after 264 weeks in the sanatorium in September 1940. He was then readmitted in November 1941 following consultation with Dr Farquharson due to the suspicion that he was intentionally breaking his splint.
In the year since his initial discharge this boy had broken his splint once and his patten several times. He is also noted to have regularly gone without his splint in the house. As such his knee was in a fixed position with 20° flexion on admission. He was discharged again in June 1942 as having good improvement and being in quiescence.
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