134 Injuries of Bone. 



— Right femur of a boy aged 13 — macerated, showing the 

 above. The lower epiphysis is quite separate from the shaft. 



The patient fell from the joisting of a house on the floor below, 

 and his right leg went through the flooring. When brought into the 

 Hospital, the house surgeon reported to Mr J. a case of common fracture 

 of the thigh-bone. He lay with the usual securities upon the limb for 

 about a fortnight before I was called to consult upon it. The boy was 

 hectic, much reduced, a dry tongue, irritable pulse, and upon the inside 

 of the knee there were deep sloughy spots. Next day, in consec[uence of 

 the restlessness of the boy during the night, I found the bone sticking 

 through the integuments, and saw from the appearance of the bone that 

 the case had been mistaken, and that, instead of a fracture communicating 

 with the joint, it was a diastasis, or separation of the epiphysis. Even 

 now I thought it not too late to amputate, with some chance of the 

 boy's surviving, but it was thought he had somewhat rallied from the day 

 preceding, and that he might lie still better on the morrow. On that day 

 he died. The dissection exhibited great suppuration within the knee- 

 joint, an immense abscess or cavity communicating with the knee-joint, 

 and extending up the bone nearly to the hip. The periosteum could be 

 torn with the fingers from half the length of the bone. Such, then, are 

 the consequence of a diastasis of the lower head of the femur, and by 

 this we see that the case classes itself with the worst kinds of fractures 

 communicating with the knee-joint. 



Apparently a small portion has been broken off the lower 

 end of the shaft. The surface of the shaft at the lower end 

 has at some places a considerable crust of new periosteal bone, 

 while at others the vascular pores are opened out. A similar 

 opening out is seen all the way up the shaft. At the front of 

 the neck a patch of the surface is eroded. These changes have 

 evidently been due to septic osteo-myelitis, an accidental 

 consequent of the injury. B. C. i. 1. M. 8. a. 



3. 249. Separation of the Epiphysis, with Mal-union.— 



Lower end of a left femur — macerated, showing the above. 



A lad, in attempting to get upon the back of a gentleman's carriage, 

 got his legs entangled within tlie spokes of the wheel, and the lower 

 extremity of the femur was broken oft', suffering that sort of accident 

 which was called diastasis. Union took place after this accident, 

 but the broken portions united irregularly, and a i)oint projected. Years 

 after this accident, and when the patient had grown into manhood, he 

 sufi'ered an accident of a still more serious nature. In carrying a burden 



