The Medical Record
Volume 21 1882, Page 180
James E Garretson
The posterior aspect of the coccyx was exposed, then a half-inch wide burr rotating at 10,000 rpm was used to remove the bone, without injuring the anterior layer of the periosteum or the attached ligaments. Less than a week after the operation, the patient was said to be doing well.
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A very neat and satisfactory method of removing the coccyx has been devised and recently practised by Professor James E. Garretson, of Philadelphia. The woman, according to Dr. Garretson's description, had sustained, thirteen years previously, a fall from a carriage, which caused a fracture, or, perhaps, dislocation of the coccyx. The displaced bone had never been adjusted, but projected forward at a right angle to the sacrum, and was somewhat movable. Great pain and general nervous disturbance had existed for years, so that the woman's health was greatly deteriorated. On December 1, 1881, the bone was removed by the use of a powerful surgical engine, which has probably never been used for the enucleation of any bone in this manner.
To appreciate the procedure, it is to recall that the coccyx is enveloped by periosteum, and necessary separated from the external world by skin, superficial fascia, some muscular tissue, and dense fibrous structures. It is separated from the rectum by pelvic fascia, fibrous tissue, and muscular fibres of the coccygeus and levator ani muscles.
The operation was done as follows : after etherization, the patient was placed in position and a median incision made through the skin and sacracoccygeal structures down to the periosteum, so that the bone, with its periosteum intact, was exposed from base to apex. This was accomplished by plunging a bistoury through the tissues, over the middle of the bone, and enlarging the incision upward and downward as much as necessary. The next step was to uncover the posterior surface by loosen ing the tissues laterally as far as the margins of the bone —this was done with a few strokes of the knife. The periosteum was then incised in the median line along the whole length of the bone and detached by means of a chisel-shaped knife, as is done in osteo plastic operations for cleft palate.