Occasionally abscesses form at a considerable distance from the
necrosed part, and terminate in sinuses, which communicate with
the diseased bone, and are consequently long and tortuous, so that
examination by the probe is rendered difficult. When necrosis is
extensive, there is a risk of fracture occurring, if motion of the limb
be permitted before a sufficient quantity of matter has been effused,
before nature has had sufficient time for the consolidation of her
substitute, and consequently before the new bone has come to resemble
the old in thickness and cohesion.
Violent inflammatory fever attends the incited action of the vessels
of the bone and periosteum which precedes necrosis. But after the
abscesses have given way the painful symptoms subside, and the health
seldom suffers to any great extent, the system becoming gradually
accustomed, as it were, to the new condition of the parts. Hectic
supervenes only when the disease is very extensive, and joints become
involved. Frequently fresh collections of matter form as each piece of
bone approaches the surface. When the effusion of new bone has extended
to the neighbourhood of a joint, its motion may be very much impeded,
and, from the limb being kept in a state of rest for the cure of the
necrosis, anchylosis may even occur.
_Treatment._—The means of preventing inflammatory action from
running high and ending in death of bone have been already alluded
to—abstraction of blood, rest, purgatives, and antimonials. When
necrosis has occurred, no interference with the bone is allowable,
unless the sequestrum is quite loose, or unless the patient’s health
is suffering severely under the discharge and irritation. When the
sequestrum can be readily moved about, or when, projecting through the
external opening, it can be laid hold of by the fingers or forceps,
attempts must be made to remove it. The surgeon ought not, however,
to allow it to approach the surface, and project externally, for the
natural discharge of the sequestrum is a much more tedious process
than the removal of it by art, and by the irritation produced during
its spontaneous ejection the inflammatory action is continued, and may
prove alarming. Long before it has appeared externally, it must have
been completely separated from the living parts, so as to admit of
ready extraction by the proper means. When it has been ascertained that
the sequestrum is separated, it ought to be laid hold of by forceps,
and moved freely upward and downward, so that any slight attachments
by which it is connected to the neighbouring parts may be destroyed,
whether these be minute filaments which still in some degree retain
their vitality, or small portions of newly deposited bone, which are
so situated as to prevent the free movement of the sequestrum. In
general, no impediment of this nature exists, and the dead bone is
easily removed. Before extraction can be accomplished, it is generally
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