Contributions to orthopoedic surgery / by Robert Jones and John Ridlon.

  • Jones, Robert, 1857-1933.
Date:
[1892-1893]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to orthopoedic surgery / by Robert Jones and John Ridlon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tract and form an obstacle to free motion at the joint. If deformity, such as flexion, has been allowed to remain during the process of recovery, the above-mentioned bands, the tendons, the fasciae, and muscles on the flexor aspect become shortened, and offer a considerable, if not insur- mountable, obstacle to any attempt at improvement of the position. If, however, recovery has taken place without deformity, ordinary use of the joint will increase the possible range of motion, and in the course of months or years as much motion will be gained as may be required for the normal use of the joint. In cases of more serious disease, when the cartilages have been destroyed and the bone ends ulcerated, recovery usually takes place with more or less complete anchylosis, fibrous or bony. In other cases still, where every reason exists for believing that the cartilage has been destroyed and the bone ulcerated, recovery takes place after proper mechanical treatment with a useful joint possessing a fair amount of motion, which as in the former cases, will increase with use. Etiology.—Heredity plays a very important part in the etiology of tubercular joint disease. Congenital tuberculosis is extremely rare, but it cannot be denied that a certain pre- disposition is transmitted from parents to children, and that in the majority of cases this is necessary to render possible the development of the disease in the joints. What this inherited predisposition depends upon, we do not know. On the other hand, it must be admitted that previously perfectly healthy individuals may be attacked, and it has also been noted that in certain families children of perfectly healthy parents and grandparents often develop tubercular affections. Tubercular disease of the joints may occur after acute infectious diseases, measles, whooping cough, and scarlatina; or after exhausting diseases, parturition, priva- tions and prolonged dissipations ; but the best conditions of nutrition offer no certain protection against its occurrence. Severe injuries, as fractures and dislocations, rarely act as exciting causes even in predisposed persons, while slight injuries, such as sprains and contusions, perhaps because more apt to become chronic from neglect of treatment, often do so, even in those where no history of predisposition can be obtained. Symptoms.—It is not possible to formulate a series of symptoms characteristic of chronic joint disease. Broadly, the majority of cases fall into one or other of three classes : (i) Primary synovial disease of non-traumatic origin; (2) Bone disease either from primary infection or secondary to disease in other tissues, associated or not with traumatism ;