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Updated: May 4, 2025
Lannelongue made a long incision below the knee which let out a large amount of pus; the tibia was found denuded for a long distance. Three places in the bone were trephined. From each of these, quantities of pus flowed. Pus from inside and outside the bone was collected with all possible precautions and was carefully examined and cultivated later.
His leg never mended; he had both sprained the knee badly, and given the tibia an awkward twist, so that the least motion was agony to him. In his fever he was constantly delirious. No one was allowed to see him, though many of the boys tried to do so, and many were the earnest inquiries for him day by day.
Well, then, you can bring me number three, the jaw." And with wonderful dexterity, never changing his position, he cut through the muscles clean down to the bone with a single motion of his wrist. He laid bare the tibia and fibula, introduced between them an implement to keep them in position, drew the saw across them once, and they were sundered.
We shall pass over many intermediary species, wherein we may see the gradual lengthening of the tongue, enabling more nectar to be extracted from the cups of corollas, and the dawning formation and subsequent development of the apparatus for collecting pollen, hairs, tufts, brushes on the tibia, on the tarsus, and abdomen, as also claws and mandibles becoming stronger, useful secretions being formed, and the genius that presides over the construction of dwellings seeking and finding extraordinary improvement in every direction.
Following the lead of Mikulicz, a considerable number of permanent cures have been obtained by resecting the portion of bone which is the seat of the tumour, and substituting for it a corresponding portion from the tibia or fibula of the other limb. In a cellular sarcoma of the humerus of a boy we resected the shaft and inserted his fibula ten years ago, and he shows no sign of recurrence.
From heavy blows received such as kicks, collision with trees or in falls in runaway accidents, the radius is occasionally fractured. In very young foals, fracture of the radius, as well as of the tibia and other bones, results from their being trampled upon by the mother. Symptomatology.
The post-mortem appearances are those of pyæmia. Differential Diagnosis. Acute osteomyelitis is to be diagnosed from infections of the soft parts, such as erysipelas and cellulitis, and, in the case of the tibia, from erythema nodosum. Tenderness localised to the ossifying junction is the most valuable diagnostic sign of osteomyelitis.
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."
The body falls backwards when the tibia makes a smaller angle than 53 degrees with the sole of the foot; 42 degrees, the steepest slope that can be climbed on foot in a ground that is sandy, or covered with volcanic ashes. When the slope is 44 degrees, it is almost impossible to scale it, though the ground permits the forming of steps by thrusting in the foot.
These were the only structures escaping division, although the ankle-joint itself was intact. There was comparatively little hemorrhage and no shock; a ligature was applied to the vessels, the edges of the wound were drawn together by wire sutures, and the cut surfaces of the tibia were placed in as good apposition as possible, although the lower fragment projected slightly in front of the upper.
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