The most frequent site of fracture, or separation of the epiphysis, is
the lower end of the femur. This may be accompanied by local swelling,
or be discovered at necropsy, or during life by means of the X-ray in
cases in which it has not been suspected. An interesting fracture
reported by the author, and also mentioned by Kaufmann and by Schoedel,
is that of the head of the femur leading to the development of coxa
vara. In the author's case, the condition was found in a scorbutic
infant who had never stood on its feet. Schoedel suggests that scurvy
may at times be the etiologic factor in coxa vara as well as in some
cases diagnosed as congenital dislocation of the hip.
On sectioning the bones longitudinally the cortex is noted to be
exceedingly thin, a mere shell and very brittle. The trabeculæ are so
thin and reduced in number that the bone has become a very fragile
structure. The marrow is no longer deep red at the ends of the long
bones, but yellowish, frequently presenting a patchy appearance. It has
a gelatinous consistency. This "Geruestmark" is one of the
characteristic anatomical changes of scurvy, and will be fully described
in considering the microscopic picture. Hemorrhages can be clearly
distinguished in the marrow, and are of varying shades denoting their
irregular occurrence. These hemorrhages were considered by Looser to be
the cause of the connective-tissue formation in the marrow, but do not
occur with sufficient constancy to warrant this interpretation.
Moreover, this "frame-work marrow" is found where there is no evidence
of previous hemorrhage.
MICROSCOPIC PATHOLOGY
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