On lengthening of the limb as a result of knee-joint disease / by W.W. Wagstaffe.

  • Wagstaffe, W. W. (William Warwick), 1843-1910.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On lengthening of the limb as a result of knee-joint disease / by W.W. Wagstaffe. 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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    When disease occurs in a knee-joint in a young growing person, and that disease, whatever its cause, becomes chronic, it is evident that the nutrition of the joint and its surround- ings must necessarily be modified. If the disease be origin- ally in the bone itself the nutrition and growth of that bone would naturally be most affected, and affected in two quite opposite directions. Growth may be arrested or may be exaggerated. If arrested the disease would appear to be very extensive, involving a large area, as may be seen in Case 20, and it may, I think, be assumed that such a condition would be found after necrosis involving the line of the epiphysis. If exaggerated, then the disease giving rise to the elongation of the bone would appear to be more local, and therefore more amenable to treatment, operative or otherwise. Any cause giving rise to chronic hypersemia of the growing line—of the junction of the epiphysis with the shaft—would almost neces- sarily tend to increased growth, and in perhaps the majority of cases such cause—secondary though it may be—is found in local necrosis. If the disease be almost entirely limited to the synovial tissues, it would not be anticipated that the growth of the bone would be disturbed, and Case 6 would appear to show this. But it is so obvious that disease beginning in synovial tissues may extend to the cartilaginous surfaces and the bones themselves that one would certainly anticipate that in many cases the conditions for excessive growth of one or other bone would be found. And this is, I think, traceable in some of the following cases where I have noted that the origin of the disease was spontaneous. But a disease origin- ally synovial and spreading through cartilage to the outer portion of the bone may not dip deep enough to affect the real line of growth. This especially might be expected to occur in more healthy constitutions, and, therefore, it is not surprising that occasionally no increase in growth would be found. Case 7 shows this to some extent, but it must be borne in mind that the patient was the oldest of the series being twenty-eight years of age, but inasmuch as she had suffered from the mischief seven years I have included the case 1KkA8E 1*. ASn®3 Tanner, ®t. 16. St. Thomas’s Hospital' Ab75, Disease of right knee since she was three years old.