File:Annals of surgery (1885) (14587174928).jpg

Identifier: annalsofsurgery31philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: University of Toronto

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alin November, 1897. The physical signs were almost identical withthose of the preceding case, except that the disability was of the rightleg. The symptoms were of sudden onset, following a fall from theknee of another man to a stone floor. As in the first case^ the patienthad suffered previously from discomfort referred to the hip. Thespecimen obtained by excision resembled the first very closely. Sevenmonths later the patient was discharged walking with two canes. In his article, Sprengel refers at some length to the tencases of fracture of the neck of the femur that I had reported,and concludes that these were in reality cases of separation ofthe epiphysis, on the following grounds : (i) That he had demonstrated this accident in two cases,while I had presented no anatomical evidence. (2) That it was an axiom that the epiphyseal line was aweak point in the bone, and therefore separation rather thanfracture was to be inferred. These arguments are of little weight, since the cases re-
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Fig. 3.—Separation of the epiphyses of the head of the femur. FRACTURE OF NECK OF FEMUR IN CHILDHOOD. 151 ported by Sprengel were in adolescents, in both of whom therewas evidence of previous weakness in the part, as shown by dis-comfort and disability preceding the acute symptoms ; while allof the ten cases reported by me were in children less thaneight years of age, who were in perfect health up to the timeof the accident. The anatomical evidence of fracture is now supplied, and,finally, it may be stated that there is neither clinical nor experi-mental nor anatomical evidence to support the assertion thatthe epiphyseal junction is a weak point in the bone of a healthychild, in the sense that separation at that point is more commonthan fracture. If this junction is ever a weak point in thissense, it is not in childhood, but rather in adolescence, when theexternal cartilage and resistant covering of periosteum havediminished to nearly the adult condition. It is at this age andin the

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