448 



BONE, PATHOLOGICAL CONDITIONS OF. 



effect, the only objection being that the result 

 is not uniform and universal. Fractures have 

 been submitted to each of the above con- 

 ditions, more especially to the maintenance of 

 exact co-aptation for months, yet has no 

 ossific union been produced ; and again a firm 

 consolidation has taken place between two 

 bones, the extremities of which had been 

 sawed off and the parts placed under circum- 

 stances that could not permit of the approxima- 

 tion of the divided surfaces. We have a case 

 published as having occurred in the hospital 

 of La Charite in Paris, in which the os calcis 

 was broken ; and although the surfaces of the 

 fragments were never completely separated, 

 yet the usual kind of ligamentous connexion 

 took place ; and for proof that a solid union 

 may occur under the circumstances above- 

 stated, we refer our readers to Mr. Crampton's 

 second case of extirpation of the knee-joint.* 



If we can subscribe to Larrey's opinion that 

 only the vessels of the bone itself can minister 

 to osseous union, and that those of the peri- 

 osteum and adjacent structures are incom- 

 petent to such function, (an opinion in which 

 he is to a certain extent supported by Mr. 

 Liston,f) it is obvious that a union between 

 fragments at a distance from each other would 

 be difficult if not impossible. Here, however, 



as well as in every other part of the history 



c -f i ii 



01 ossinc union, it is only conjecture. \\e 



have nothing like substantial definite proof, 

 and must only rest satisfied with a knowledge 

 of the fact without being able to explain it, 

 that the medium of union between fragments, 

 the faces of which are withdrawn from each 

 other, is in general not osseous. 



Whatever may be the operation of this cause, 

 that of the other two is by no means so ob- 

 vious. The second J has been generally ad- 

 duced in explanation of the non-union of 

 fractures of the neck of the thigh-bone, but 

 perhaps without being entitled to the impor- 

 tance that has been attached to it. If a part 

 is only possessed of a degree of organisation 

 barely sufficient to preserve its vitality in ordi- 

 nary circumstances, but inadequate to accom- 

 plish any process of repair, it should follow 

 that any violence offered to it ought to cause 

 its death, or at least its removal by the ab- 

 sorbents, and in such case the caries or exfo- 

 liation of a fragment of bone might be easily 

 understood. But these are not the results of 

 fracture of the neck of the femur except in 

 very rare and anomalous cases ; and, on the 

 contrary, there is scarcely an example of exami- 

 nation after death that did not exhibit a conside- 

 rable display of reparative energy, although the 

 results were not such as to produce ossific union. 

 Professor C'olles has published twelve cases 

 of post-mortem examinations of this accident, 

 in some of which he observed the appearance 

 of ivory-like patches on the surface of the 

 superior fragment, evidently proving the ex- 



* Dublin Hospital Reports, vol. iv. p. 236. 



t Elements of Surgery. 



t Cooper's Surgical Essays. 



Dublin Hospital Reports, vol. ii. p. 334. 



istence of considerable ossific powers in this 

 part. Besides, this condition of the head of 

 the bone has been assumed rather than proved. 

 On the most attentive examination, we have not 

 been able to observe any deficiency of vascu- 

 larity within it; and if there is any difference 

 between the head and neck and shaft, we are 

 rather disposed to believe the head to be pos- 

 sessed of the highest degree of organization. 



The advantage of the most absolute rest to the 

 cure of fracture has been observed in all ages, 

 and yet is it doubtful how far its influence on 

 the question under consideration can be appre- 

 ciated. Few fractures can be kept in a more 

 perfect state of repose than those of the patella 

 or of the heel, yet the union in both these 

 cases is always ligamentous. It would appear 

 as if constant although very trifling motion 

 was more prejudicial than occasional shocks 

 however rude and productive of greater dis- 

 turbance, and this perhaps is the reason why 

 false joints so frequently occur after fractures 

 of the clavicle, even although the fragments 

 have never suffered displacement, as occurs 

 when the bone is broken near its acromial 

 extremity. 



Suppuration may occur in the osseous tissue 

 under a variety of conditions, as to situation, 

 as to the character of the matter, and as to 

 whether it is produced by or connected with 

 any constitutional or specific taint. Pus is 

 occasionally, though not frequently contained 

 in a cyst or sac within a bone, as the result of 

 inflammation, and resembling the common ab- 

 scess in the soft parts. These collections are 

 never very large ; they are usually situated in 

 the thick and spongy parts of the bones, and 

 have a strong tendency to burst into the neigh- 

 bouring joint. We have seen a case of abscess 

 in the head of the tibia, which appeared to 

 have opened into the knee-joint even after it 

 had burst externally. The disease had pre- 

 viously existed for months, the patient suf- 

 fering very little either locally or constitutionally 

 until the communication with the cavity of the 

 articulation was established, when the symp- 

 toms became so aggravated as to demand the 

 speedy removal of the limb. The symptoms 

 of suppuration within a bone are exceedingly 

 obscure, nor is there any certainty until the 

 abscess has burst and a probe can be passed 

 into the cavity, particularly if the inflammation 

 has not been attended with enlargement of the 

 bone. The pain is said to be agonizing, but 

 this is not universally true, and we may infer 

 that suppuration has taken place " by the 

 violent symptoms of active inflammation les- 

 sening, by cold fits and shivering occurring, 

 by a remission of pain with an increased sense 

 of weight in the part ; but all these are fal- 

 lacious, and no external marks of suppuration 

 are at first to be observed, the disease affecting 

 parts too deep to be seen with the eye or felt 

 with the finger."* 



Suppuration on the surface of a bone is of 

 very common occurrence, and so constantly 

 complicated with affections of the periosteum, 



* Wilson on the Bones and Joints. 



