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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.
In the macerated specimen, the sequestrum appears small in proportion to the large cavity in which it lies. All these changes are revealed in a good skiagram, which not only confirms the diagnosis, but, in many instances, demonstrates the extent of the disease, the presence or absence of a sequestrum, and the amount of new bone on the surface.
When growing in the interior of a bone it causes a spindle-shaped enlargement of the shaft, which in the case of a phalanx or metacarpal bone may resemble the dactylitis resulting from tubercle or syphilis. A chondroma appears as a clear area in a skiagram.
In most instances the patient has carefully observed his own symptoms, and is aware not only of the existence of the loose body, but of its erratic appearance at different parts of the joint. This feature serves to differentiate the lesions from a torn medial meniscus in which the pain and tenderness are always in the same spot. As the body usually contains bone, it is recognisable in a skiagram.
This affection may be associated with a spinous projection from the bone, which is capable of being recognised in a skiagram. The soft parts of the heel are turned forwards as a flap, the bursa is dissected out, and the projection of bone, if present, is removed.
Dislocation of the adjacent joint has been chiefly observed at the hip; it may result from effusion into the joint and stretching of the ligaments, or may be the sequel of a purulent arthritis; the signs of dislocation are not so obvious as might be expected, but it is attended with an alteration in the attitude of the limb, and the displacement of the head of the bone is readily shown in a skiagram.
A skiagram of a bone in which there is a chondroma shows a clear rounded area in the position of the tumour, which must be differentiated from similar clear areas due to other kinds of tumour, especially the myeloma; when it has undergone calcification or ossification, it gives a shadow as dark as bone. [Illustration: FIG.
A skiagram shows the extent of the mass and its relationship to the femur. The treatment consists in excising the bony mass.
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