Volume 1

Descriptive catalogue of the specimens illustrating surgical pathology in the museum of University College, London.

  • University College, London. Museum.
Date:
1899-1906
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Descriptive catalogue of the specimens illustrating surgical pathology in the museum of University College, London. Source: Wellcome Collection.

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    FEAOTTJBES. surface of the swelling is smooth and regular. At a short distance below its middle the hbula is bent forwards, and presents a rounded enlargement which externally is deeply grooved traasversely. The enlargement is in no way connected witn that ot the tibia, and its cut surface presents a denser appearance. 7910 Microscopic Strucfure--The tissue forming the enlargement of the tibia presents narrow anasto- mosing trnbeculro of bone enclosing spaces filled with cellular and fibrillMted tissue : the trabecula; contani bono-corin.sclos but no Haversian systems, and are in parts fringed with one or two Slttd?.!^^^^^^ ''^^''^^'^ Howship's lacunic containing multi- _ From a female child, years, who at the age of 1 year h^id fallen from a chair and injured her leg so as to disable her for a fortnight. Swelling of the limb was first noticed a year and a half after the injury. The swelling increased, and four years after the iniury the leg was amputated with the idea that the swelling was an ossifying sarcoma. The speci- men 13 in all probability an example of hypertrophied callus foUowing a fracture of the tibia and fibula. (See Trans. Path. Soc. vol. xsxri. 1895, p. 388.) 49. The right tibia and fibula of a child, the former being divided vertically in its whole length and the latter in its lower part only. The tibia presents an undue curvature, which aiSects its whole length, and has its convexity directed forvvards and inwards ; the middle third of the bone is enlarged, the enlargement being most marked at the junctions of the middle with the upper and lower thirds, so as to produce two swellings on the bone. The lower of these swellings is much the larger, and immediately below it distinct mobility is present, and the curvature is more marked than at any other part of the bone. The inner surface of the tibia in this position is marked by a recent incision into its substance. The section of the bone presents the following appearances:—the upper extremity and the upper part of the shaft are normal; from the anterior surface of the bone 2 cm. from the epiphysial cartilage a bar of compact bone 5 mm, in thickness passes down- wards and backwards to join the posterior compact wall. From this level down- wards to that of the fi-acture the interior of the bone is occupied by a dense osseous substance, crossed by a second ridge of compact bone similar to that above described. Especially in front, the compact wall of the shaft is in parts thinned or wanting. At the level of this fracture immediately below the lower enlargement, the substance of the shaft is almost completely replaced by soft tissue, which invades the substance of the lower fragment for a distance of about 1 cm. The lowest 2 cm. of the shaft and rhe lower extremity of the bone are normal. The fibula in its upper part is normal. In its lower fourth the shaft presents an irregular fusiform enlargement and a marked curvature directed inwards. The section shows that a fracture has at some time occurred at a distance of 2 cm. above the lower epiphysial line. Union has occurred, allowing a slight amount of movement. 7249 Microscopic Structure.—In the tibia, the soft substance uniting the fragments consists of dense white fibrous tissue. The enlarged portion of the shaft is composed of irregular trabeculas of bone separated by spaces occupied by somewhat loose and cellular connective tissue. In many places a layer of osteoblasts lies in contact with the trabecula3, in others small groups of multinucleated cells are present; the connective tissue is traversed by blood-vessels, most of which are wide and thin-walled, but some narrow and having a distinct muscular coat. Normal marrow-tissue is not present. The enlarged portion of the fibula has a similar structure, except that, in place of tlie dense fibrous tissue at the line of fracture, there is a zone of cartilage, the surfaces of which have been partly converted into bone. From a inale child 3 years of age, in whom bending of the tibia began at Ihe age of 5 moutlis. The limb was treated with splints for 12 months without any improvement resulting, and the patient was afterwards admitted to St. Mary's Hospital, where the leg was straigliieued and put in plaster of Paris for 1 month. Bending of the bone rapidly recurred. Three months later the patient was operated on at Bedford, and the leg somewhat straightened and put in plaster of Paris; bonding of the bono returned gradually after the pla.stor was removed. Nine montlis after the last operation the patient was admitted to U. 0. H., and it was decided to perform cuneiform osleotcmiy, but on cutting through llie bone it was found to contain soft growth. Amputation was performed a week later. Five yeai s alter the ani]Dutii- tion the patient was reported as being in good health. (Mr. Godlee and Mr. Pollard's Ciu>c- book, 1894, vol. i. p. 58.)