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Updated: May 6, 2025
The condition extends right up to the articular cartilage, or, in the case of adolescent bones, up to the epiphysial cartilage. Prognosis. The condition does not appear to affect the general health. The future is concerned with the local conditions, and, especially in the case of the femur, with its liability to fracture; so far as we know there is no time limit to this.
A tumour of bone may grow from the cellular elements of the periosteum, the marrow, or the epiphysial cartilage. Primary tumours are of the connective-tissue type, and are usually solitary, although certain forms, such as the chondroma, may be multiple from the outset. Periosteal tumours are at first situated on one side of the bone, but as they grow they tend to surround it completely.
The periosteum of the diaphysis is easily separated hence the facility with which the pus spreads along the shaft; but in the region of the ossifying junction it is raised with difficulty because of its intimate connection with the epiphysial cartilage.
In the upper limb the more active epiphyses are at the shoulder and wrist, and these also are the last to unite. The activity of the epiphysial cartilage may be modified as a result of disease.
Interference with growth is comparatively common, and may involve only the epiphysial junctions in the immediate vicinity of the joint affected, or those of all the bones of the limb. This is well seen in adults who have suffered from severe disease of the hip in childhood the entire limb, including the foot, being shorter and smaller than the corresponding parts of the opposite side.
The nutrient artery, after entering the medullary canal through a special foramen in the cortex, bifurcates, and one main division runs towards each of the extremities, and terminates at the ossifying junction in a series of capillary loops projected against the epiphysial cartilage.
The cartilage of the epiphysial disc proliferates actively and irregularly, so that it becomes softer, thicker, and wider, and gives rise to a visible swelling, best seen at the lower end of the radius and lower end of the tibia, and at the costo-chondral junctions where the series of beaded swellings is known as the "rickety rosary."
Except where muscles are attached it is easily separated from the bone; at the extremities it is intimately connected with the epiphysial cartilage and with the epiphysis, and at the margin of the latter it becomes continuous with the capsule of the adjacent joint.
An obliquity of the bone may result when one half of the epiphysial cartilage is destroyed and the other half continues to form bone, giving rise to such deformities as knock-knee and club-hand. Deformity may also result from vicious union of a pathological fracture, permanent displacement of an epiphysis, contracture, ankylosis, or dislocation of the adjacent joint.
Any diseased process that affects the periosteum is spoken of as periostitis; the term osteomyelitis is employed when it is located in the marrow. The term epiphysitis has been applied to an inflammatory process in two distinct situations namely, the ossifying nucleus in the epiphysis, and the ossifying junction or metaphysis between the epiphysial cartilage and the diaphysis.
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