Volume 1
Manual of surgery / by Alexis Thomson and Alexander Miles.
- Thomson, Alexis.
- Date:
- 1904
Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![form constitute tlie new tendon fibres. In tlie course of this repurativo process it is not uncommon for the tendon and its sheatli to become adlierent, leading to impeded movement and stitfuess. Repair of Cai-ti/af/e.—Solutions in continuity of cartilage are usually repaired by ordinary cicatricial fibrous tissue. This takes place, for example, when a portion of articular cartilage is divided by incision or by a fracture implicating the articular end of a bone. In other cases, such as in fractures of costal cartilage or of the cartilages of the larynx, the cicatricial tissue is ultimately replaced by bone. It is, however, possible for a metaplastic transformation of connective-tissue cells into cartilage cells to take place, the characteristic hyaline matrix being secreted by the new cells. This is sometimes observed as an intermediaiy stage in the healing of fractures, especially in young bones. It may also take place in the regeneration of lost portions of cartilage, provided the new tissue is so situated as to constitute part of a joint and to be subjected to pressure by an opposing cartilaginou.s surface. This is illustrated by what takes place after excision of joints where it is desired to restore the function of the articulation. By carrying out passive movements between the constituent parts, the fibrous tissue covering the ends of the bones becomes moulded into shape, its cells take on the characters of cartilage cells, and forming a matrix, so develop a new cartilage. Conversely it is observed that when articular cartilage is no longer subjected to pressure by an opposing cartilage, it becomes transformed into fibrous tissue, as may be seen in deformities attended with (lis])lacenK!nt of articular surfaces, such as hallux valgus or club-foot. Jiepair of JJoiir.—The re[)air of bone is most conveniently considered in relation to fractures, l)ut the steps in the process are practically identical when the bone has been divided in the operation of osteotomy, in resection or excision. Repair of MxHcla.—Neither luistriped nor striped nuisclc seems to be capable of being regenerated to any but a moderate degree. If the end.s of a divided muscle be at once brought into ap|)osition by stitches, priniary union takes place with a minimum of interveiung fibrous tissue. Tlie nuclei of the nuisclc fibres in close proximity to this young cicatricial tissue liroliferate, and a few new iniLscIo fibres may be developed, but any gross loss of muscular tissue is replaced by a fibrous](https://iiif.wellcomecollection.org/image/b21511093_0001_0031.jp2/full/800%2C/0/default.jpg)
