A Treatise on Fractures, Luxations, and Other Affections of the BonesDesault, P.-J. (Pierre-Joseph)
Science
A Treatise on Fractures, Luxations, and Other Affections of the Bones
Desault, P.-J. (Pierre-Joseph)
Dislocations; Fractures; Surgery
4. Concretions of the joints do not always assume the same aspect. They
vary greatly as to number, size, figure, structure, &c. In general,
these bodies exist singly; sometimes, however, two of them are found
in the same joint, and then they may be extracted either at the same
time, or in succession, as was once done by Desault. Some English
surgeons have also met with two concretions, and Morgagni has found
even twenty-five, in the same joint.
5. They vary also in size. The largest ever met with by Desault, was
fourteen lines in its longest, and ten in its shortest diameter. Six
lines diameter in every direction, was the measure of the smallest one
that occurred in his practice.
6. Their figure is sometimes lenticular and smooth on both sides,
sometimes unequal, rough in one part, even in another, concave on
one side, convex on the opposite, sometimes marked around the
circumference and sometimes not with reddish points, and having
occasionally a stem of a cellular texture and of some length, as may
be seen in a paper by Theden. They usually consist of a single mass,
but are in some cases divided into several lobules united by a kind of
ligaments, as in the fourth case related in the Journal of Surgery.
Though most frequently detached and floating in the interior of the
joint, they have yet been found adhering by means of small portions of
cellular substance, loose and capable of being stretched, or tight,
hard, and even of a ligamentous nature.
7. If, from the external figure, we pass to the structure of these
bodies, we will find them existing in three different states. Sometimes
purely cartilaginous, sometimes completely bony, they at other times
partake of both these states, in which case a bony nucleus is covered
with a cartilaginous crust. Out of five cases, recorded by Desault,
three are of the first, and two of the third kind. Many authors have
met with the second kind, particularly Morgagni, who has even found in
the same joint, some bodies of a bony and others of a cartilaginous
nature. Hence it appears, that this variety of structure is to be
attributed to the longer or shorter standing of the disease, that every
concretion must pass successively through these three states, and that
there is a great analogy between the formation of such bodies and
natural ossification.
8. If we examine a body of the third kind cut in two through the
middle, we will find it red and vascular in the centre, like an
epiphysis, even when it is floating in the joint perfectly loose and
free from adhesion.
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