Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
Deformity, with stiffness and locking at the adjacent joint,
especially at the elbow, may result from imperfect reduction, or from
exuberant callus. Arrest of growth of the bone in length is a rare
sequel, and when it occurs, it is due, not to premature union of the
epiphysis with the shaft, but to diminished action at the ossifying
junction.
When the growth of one of the bones of the leg or forearm is arrested
after separation of its epiphysis while the other bone continues to
grow, the foot or hand is deviated towards the side of the shorter
one.
Partial separations may be overlooked at the time of the accident and
cause trouble later from bending of the bone, as in one variety of
coxa vara. The epiphysis at the lower end of the femur may be
displaced into the ham and press on the popliteal vessels.
_Treatment._--The general principles which govern the treatment of
fractures apply equally to epiphysial separations, the essential being
the accurate replacement of the epiphysis.
In _compound separations of epiphysis_, the end of the diaphysis may
be pushed through the skin. The entrance of sepsis may prove an
obstacle to any operative measure that would otherwise be indicated.
CHAPTER II
INJURIES OF JOINTS
SURGICAL ANATOMY--INJURIES: _Contusions_; _Wounds_; _Sprains_;
_Dislocations_--TRAUMATIC DISLOCATIONS: _Causes_: _Varieties_;
_Clinical features_; _Treatment_--Compound
dislocations--Old-standing dislocations.
#Surgical Anatomy.#--The function of a joint is to permit of the
movement of one bone upon another. The articular surfaces are covered
with a thin layer of hyaline cartilage, and are retained in apposition
by the tension of ligaments and of the muscles surrounding the joint.
The articular capsule (capsular ligament) is directly continuous with
the periosteum, and is lined by a synovial layer, which at the line of
attachment of the capsule is reflected on to the bone as far as the
articular cartilage. The synovial layer invests intra-articular
ligaments, and is projected into the interior of the joint in the form
of loose folds wherever the articulating surfaces are not in immediate
contact. The surface of the synovial layer is covered with minute
processes or villi, which in diseased conditions may become
hypertrophied. The synovia owes its lubricating property to mucin,
derived from the solution of the endothelial cells on the free surface
of the synovial layer. The opposing surfaces of a joint being always
in accurate contact, the so-called cavity is only a potential one. If
fluid is poured out into the joint, the synovial layer and the capsule
are put upon the stretch, causing discomfort or actual pain, which is
partly relieved by slightly flexing the joint. If the distension
persists, the ligaments become elongated and the joint unstable.
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