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Updated: June 28, 2025
We have met with a fibroma in the interior of the lower end of the femur of an adult, causing expansion of the bone with decided increase in girth and liability to pathological fracture; it is possible that this represents the cured stage of osteomyelitis fibrosa. Myxoma, lipoma, and angioma of bone are all rare.
The myeloma is also to be diagnosed from chondroma, from sarcoma, and from osteomyelitis fibrosa cystica. [Illustration: FIG.
The most common is an osteomyelitis commencing in the marrow exposed in a wound infected with pyogenic organisms. In amputation stumps, fungating granulations protrude from the sawn end of the bone, and if necrosis takes place, the sequestrum is annular, affecting the cross-section of the bone at the saw-line; or tubular, extending up the shaft, and tapering off above.
Osteomyelitis is rare in the bones of the carpus and tarsus, and the associated joints are usually infected from the outset. In flat bones, such as the skull, the scapula, or the ilium, suppuration usually occurs on both aspects of the bone as well as in the marrow. Clinical Features. The constitutional symptoms, which are due to the associated toxæmia, vary considerably in different cases.
The lesion consists in a gummatous infiltration of the soft parts surrounding the phalanx, or a gummatous osteomyelitis, but there is practically no tendency to break down and discharge, or to the formation of a sequestrum as is so common in tuberculous dactylitis.
The disease commences and is most intense in the marrow of the ossifying junction at one end of the diaphysis; it may commence at both ends simultaneously bipolar osteomyelitis; or, commencing at one end, may spread to the other. The changes observed are those of intense engorgement of the marrow, going on to greenish-yellow purulent infiltration.
Young subjects are attacked by diphtheria, tuberculosis, acute osteomyelitis, and some other diseases with greater frequency and severity than those of more advanced years. In different races, localities, environment, and seasons, the pathogenic powers of certain organisms, such as those of erysipelas, diphtheria, and acute osteomyelitis, vary considerably.
Infection with the staphylococcus albus, the streptococcus, or the pneumococcus also causes a mild form of osteomyelitis which may go on to suppuration. It occurs in adults, being met with up to the age of fifty or sixty, and is characterised by the insidious development of a swelling which involves a considerable extent of a long bone.
So long as there is dead bone there will be suppuration from the granulations lining the cavity in which it lies, and a discharge of pus from the sinuses, so that the mere persistence of discharge after an attack of osteomyelitis, is presumptive evidence of the occurrence of necrosis.
The second type is met with in relation to epithelioma occurring in a sinus, the sequel of suppurative osteomyelitis, compound fracture, or tuberculous disease. The patient has usually had a discharging sinus for a great number of years: we have known it to last as many as fifty.
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