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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.
The final disorganisation of the joint is indicated by abnormal mobility and grating of the articular surfaces, or by spontaneous displacement of the bones, and this may amount to dislocation. In the acute arthritis of infants, the epiphysis concerned may be separated and displaced.
Rodenbaugh mentions a most interesting case of beans sprouting while in the bowel. Harrison relates a curious case in which the swallowed lower epiphysis of the femur of a rabbit made its way from the bowel to the bladder, and was discharged thence by the urethra.
The separated epiphysis may be kept in place by the periosteum, but when this has been detached by the formation of pus beneath it, the epiphysis is liable to be displaced by muscular action or by some movement of the limb, or it is the diaphysis that is displaced, for example, the lower end of the diaphysis of the femur may be projected into the popliteal space.
It may be less evident to the eye than to the fingers, and is best appreciated by gently stroking the bone from the middle of its shaft towards the end. The maximum thickening and tenderness usually correspond to the junction of the diaphysis with the epiphysis, and the swelling tails off gradually along the shaft.
The infection may spread to the adjacent joint, either directly through the epiphysis and articular cartilage, or along the deep layer of the periosteum and its continuation the capsular ligament. When the epiphysis is intra-articular, as, for example, in the head of the femur, the pus when it reaches the surface of the bone necessarily erupts directly into the joint.
When the cocci gain access to the joint, the lesion assumes the characters of a purulent arthritis, which, from its frequency during the earlier years of life, has been called the acute arthritis of infants. Separation of an epiphysis nearly always results in infection and destruction of the adjacent joint.
The shadow of the new case or involucrum with its wavy contour is also in evidence, with its openings or cloacæ, and is mainly responsible for the increase in the diameter of the bone. The skiagram may also show separation and displacement of the adjacent epiphysis and destruction of the articular surfaces or dislocation of the joint. Sequelæ of Acute Suppurative Osteomyelitis.
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.
Gibson too was touched by it, and made it a point of honour to give him a fair field, all the time sincerely hoping that Molly would not be such a goose as to lend a willing ear to a youth who could never remember the difference between apophysis and epiphysis. Mrs.
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