On the healing of aseptic bone cavities by implantation of antiseptic decalcified bone / by N. Senn.

  • Nicholas Senn
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: On the healing of aseptic bone cavities by implantation of antiseptic decalcified bone / by N. Senn. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    operation has taken place more than a year after the operation, it inu.st be assumed that the entire cavity has become filled with new bone. Case III. Plastic osteomyelitis of the lower end of the tibia following fracture of the fibula.—A man, twenty-eight years old, was admitted into the Milwaukee Hospital, April 18, 1888. General health good. No hereditary predisposition. Five years ago he sustained a fracture of the fibula with sever© sprain of ankle-joint. After a slow recovery from this injury he was able to walk about until two years later, when a fixed pain appeared in the lower end of the tibia, which gradually increased in severity for several months, followed by swelling and marked tenderness just above the internal malleolus. When examined the lower portion of the tibia was found uniformly enlarged, and a localized point of tenderness was detected over the inner surface of the bone just above the epiphyseal line. At this point an opening was made into the tibia, after carefully reflecting the periosteum, one-third of an inch in length and one-fourth of an inch in width, and extending its depth beyond the centre of the bone. The bone was harder than in a state of health, consequently I explored the surrounding tissue with a drill from the cavity, but failed in detecting evidences of suppuration. The cavity was filled with one large piece of decalcified bone. Wound closed by buried and superficial sutures. The jjain ceased immediately after the operation and has never returned since. The wound was completely healed in two weeks. The limb Avas kept at rest for a number of Aveeks for the purjiose of favoring the process of repair in the interior of the bone. The cavity has become filled Avith neAV bone, and the surface of the tibia at the site of operation presents a smooth and eA'en surface. The osteo- myelitis in this case Avas of the plastic variety, and hence the operation Avas done entirely in aseptic tissue, and it Avas not deemed necessary to re.sort to disinfection of the cavity or to iodoformization of the bone chips. The pain Avas evidently due entirely to tension, and Avas promptly relieved by the operation. Case IV. Secondai'y central suppurative osteomyelitis of head of tibia. —A female, thirty years old, Avas admitted into the Mihvaukee Hos- pital June 5, 1888. Eight years ago I made an extensive operation for necrosis of the central and loAver portion of the tibia which had followed an attack of osteomyelitis Avhen she Avas a child. A number of sequestra Avere removed and suppurating cavities laid open. After a number of months the Avound finally closed, leaving quite a defect in the bone at the site of operation with the cicatrix firmly adherent to the bone. She remained Avell until tAvo months ago, Avhen, Avithout any ajiparent cause, she Avas attacked Avith a seA^ere pain in the upper portion of the same bone. The suffering increased in intensity from day to day until the pain became so severe that opiates failed to procure relief. No swelling of the bone or soft parts could be detected, but OA'^er the anterior sui’face of the head of the tibia in close proximity to the knee-joint a Avell- defined circumscribed area of tenderness could be mapped out. The entire limb Avas thoroughly disinfected and Avhile the limb Avas ele\'ated Esmarch’s constrictor Avas ap])lied around the thigh. A straight incision Avas made ])arallel to the limb through the centre of the tender surface doAvn to the bone. The periosteum Avas found slightly thickened and could be easily separated from the underlying bone. The bone itself Avas exceedingly vascular and not as dense as in