Bone needle

“ If the bone is not diseased, but is denuded of flesh all around, it is to be sawn in the same manner, for bones which are disengaged from the other parts all around cannot possibly incarnate. In like manner, the extremity of a bone near a joint, if diseased, is to be sawn off; and often, if the whole of a bone, such as the ulna, radius, tibia, or the like, be diseased, it is to be taken out entire. But if the head of the thigh-bone, or pelvis, or a vertebra of the spine be diseased, we must not attempt to operate upon them for fear of the adjoining arteries. ”

“ It consists of two layers, an outer fibrous and an inner cellular layer; the cells, which are called osteoblasts, are continuous with those lining the Haversian canals and the medullary cavity.
The arrangement of the blood vessels determines to some extent the incidence of disease in bone. The nutrient artery, after entering the medullary canal through a special foramen in the cortex, bifurcates, and one main division runs towards each of the extremities, and terminates at the ossifying junction in a series of capillary loops projected against the epiphysial cartilage. ”

“ On longitudinal section of a long bone during the active stage of the disease, the marrow is seen to be replaced by a vascular young connective tissue which encroaches on the surrounding spongy bone, reducing it to the slenderest proportions; the formation of bone from the periosteum does not keep pace with the absorption and replacement going on in the interior, and the cortex may be reduced to a thin shell of imperfectly calcified bone which can be cut with a knife. The young connective tissue which replaces the marrow is not unlike that seen in osteomalacia ”

“ The inner shell of bone, as may be seen in the above sketch, perishes more extensively than the outer; and this arises probably from inflammation of the medullary membrane, in consequence of exposure, or, perhaps, from its being sometimes injured by the operator or assistants seizing the bone rudely to steady the stump, in order to facilitate the ligature of the vessels. In experiments on animals, the disturbance and injury of the medullary membrane is followed by internal necrosis, thickening of the outer living shell, and effusion betwixt the periosteum and bone. ”

“ The disorder of growth is confined to those elements of the skeleton where a core of bone formed in cartilage comes to be encased in a sheath of bone formed beneath the periosteum. To indicate this abnormality the name _diaphysial aclasis_ has been employed by Arthur Keith at the suggestion of Morley Roberts.
Bones formed entirely in cartilage are exempt, namely, the tarsal and carpal bones, the epiphyses of the long bones, the sternum, and the bodies of the vertebrae. Bones formed entirely in membrane, that is, those of the face and of the cranial vault, are also exempt. ”

“ The broken extremities of the bones become intimately united by bony matter passing from one to the other. The mass of new bone on the outside, formed by the ossification of the callus, being no longer wanted, is absorbed; by degrees the whole of it disappears, and the bone is left having the same dimensions which it had before the occurrence of the accident.
The process of union is completed in young persons sooner than in those advanced in life; in the upper extremities sooner than in the lower; and in smaller animals more speedily than in man. ”

“ If any osseous deposit has taken place, it is absorbed; the ends of the bone are diminished in size by interstitial absorption; ligamentous or fibro-cartilaginous tissue is formed round the wasted extremities; and the surrounding cellular tissue being thickened and condensed, a sort of synovial pouch is formed, in which the ends, by this time smooth and rounded off, move freely. The limb is shortened in some degree, and its actions are very much diminished in force, there being no sufficient support for the muscles. ”

“ The bones, cartilages, ligaments, and synovial membrane are insensible when in health; yet they are supplied with organic nerves, as well as with arteries, veins, and lymphatics.
Observation. The joints of the domestic animals are similar in their construction to those of man. To illustrate this part of the body, a fresh joint of the calf or sheep may be used. After divesting the joints of the skin, the satin-like bands, or ligaments, will be seen passing from one bone to the other, under which may be observed the membranous bag, called the capsular ligament. ”

“ Finally, this red zone was covered with a fairly thick layer of 42 white bone: this was the layer formed after the madder had been left off.... We shall have no further difficulty in understanding whence transudes the osseous juice that was thought necessary for the formation of callus and the filling-up of the wounds of the bones, now we see that it is the periosteum that fills up the wounds, or is made thick round the fractures, and afterward becomes of the consistence of cartilage, and at last acquires the hardness of bones. ”

“ Those at the knee, for example, contribute more to the length of limb than do those at the hip or ankle, and they are also the last to unite. In the upper limb the more active epiphyses are at the shoulder and wrist, and these also are the last to unite.
The activity of the epiphysial cartilage may be modified as a result of disease. In rickets, for example, the formation of new bone may take place unequally, and may go on more rapidly in one half of the disc than in the other, with the result that the axis of the shaft comes to deviate from the normal, giving rise to knock-knee or bow-knee. ”

“ The thumb-nail guards the knife from in any way scoring the flap. (4.) This process is continued till the tuberosity of the os calcis is fairly turned, and the tendo Achillis nearly reached. Shifting his left hand he then extends the foot, and joins the extremities of the first incision by a transverse one right across the instep. (5.) Thus he opens the joint between the astragalus and tibia, (6.) divides the lateral ligaments, disarticulates, and still keeping close to the bone, removes the foot by the division of the tendo Achillis. ”

“ If he finds an arm has lost motion, he goes to arm to explore for cause. He can begin his hunt for cause at hand, explore it carefully for wounds, strains or any lesion that could injure nerves of the arm. If he finds no probable cause there, he should explore bones for dislocations or strains of ligaments at elbow; if he finds no defect there sufficient to locate cause in lower arm or hand; he has only two more places left to inspect, the shoulder and neck with their [Pg 42] articulations of bone and muscles. ”

“ Necrosis, fortunately, seldom occurs in the heads of the long bones, or penetrates the separation betwixt the cancelli of the shaft and the epiphysis. Bits of dead bone in the articular ends, however, very often lead to disease in the joint. ”

“ If the distension persists, the ligaments become elongated and the joint unstable.
The common origin of bone, cartilage, periosteum, and synovial layer from one parent tissue of the embryo, accords with the readiness with which any one of these tissues may be converted into another under traumatic or pathological influences; and how in ligaments and in synovial membrane foci of hyaline cartilage may form and, after increasing in size, undergo ossification.
Joints derive an abundant blood supply through the articular arteries. ”

“ It is rarely necessary to remove more of the bone than merely its articular extremity (when performed for disease of the joint) , and if possible this should be done inside the capsule, i.e. through an incision in the capsule, but without involving its attachment to the neck of the bone. When the glenoid is also diseased, mere gouging or scraping the cartilaginous surface will not suffice, but the neck must be thoroughly exposed,{116} so that the whole cup of the glenoid may be removed by powerful forceps. ”

“ The most common is an osteomyelitis commencing in the marrow exposed in a wound infected with pyogenic organisms. In amputation stumps, fungating granulations protrude from the sawn end of the bone, and if necrosis takes place, the sequestrum is annular, affecting the cross-section of the bone at the saw-line; or tubular, extending up the shaft, and tapering off above. The periosteum is more easily detached, is thicker than normal, and is actively engaged in forming bone. ”

“ The external investment—the periosteum—is thick and vascular during the period of growth, but becomes thin and less vascular when the skeleton has attained maturity. Except where muscles are attached it is easily separated from the bone; at the extremities it is intimately connected with the epiphysial cartilage and with the epiphysis, and at the margin of the latter it becomes continuous with the capsule of the adjacent joint. ”

“ Although the tissue elements in this disease resemble those of a new growth arising in the marrow, they differ in their arrangement and in their method of growth; there is no tendency to erupt through the cortex of the bone, to invade the soft parts, or to give rise to secondary growths.
_Clinical Features._--The onset of the disease is insidious, and attention is usually first directed to it by the occurrence of fracture of the shaft of one of the long bones--usually the femur--from violence that would be insufficient to break a healthy bone. ”

“ The head of the os femoris, situated where it is usually found in luxations outward and upward, was surrounded by a cartilage equally tumefied.
5. Here the cause of the displacement of the os femoris was evident. The cartilages becoming tumefied, in consequence of the contusion and violence done to them, had by degrees, filled up the acetabulum, forcing out in the same gradual manner the head of the bone. Hence arose the original lengthening of the limb. ”

“ A very tough skin—a sheathe—surrounds the neck with blood vessels, nerves, muscles, bones, ligaments, fascia, glands great and small, throat and trachea. In bones we find a great canal for spinal cord. It is well and powerfully protected by a strong wall of bone, so no outer pressure can obstruct the flow of passing fluids, to keep vitality supplied by brain forces, but with all the guards given to protect the cord, we find that it can be overcome by impact fluids to such degree as to stop blood and other fluids from supplying lungs and all below. ”

“ For the initial puncture in sensitive or inflamed tissue, it is proper to use a needle of the finest lumen so as to cause the least possible amount of pain. The ordinary needle, which comes with the usual hypodermic outfit, is about the proper length for the ordinary work already mentioned, but could be improved upon for anesthesia by being made a little finer in calibre. This length (three-quarters of an inch) will be frequently found insufficient to reach the deeper tissues and in the [Pg 239] removal of a more or less rounded growth, a longer needle must be selected at the start. ”

“ Such is not my object, but to place the Osteopath's eye of reason on the hunt of the great whys that the knife is useful at all, I am sure it comes often to remove growths and diseased flesh and bone that have [Pg 155] gotten so by man's ignorance of a few great truths. 1st, If blood is allowed to be taken to a gland or organ, and not taken away in due time the accumulation will become bulky enough to stop the excretory nerves and cause local paralysis; then the nutrient nerves proceed to construct tumors, and on and on until there is no relief but the knife or death. ”

“ Lining the medullary and cancellous cavities is a delicate connective tissue lining, the endosteum, which contains many bone-forming cells, while on the outside of the bone, except at the articular ends, is the periosteum with its outer protective layer and its inner vascular layer containing osteoblasts or bone-forming cells. The periosteum is essential for the growth of new bone where the old bone has died, and if the periosteum is removed from healthy bone the part beneath is liable to die, as it is by the constant growth of the osteoblasts that the bone grows and is renewed. ”

“ As the muscles and bones have a richer blood supply than the integument, the death of skin and subcutaneous tissues extends higher than that of muscles and bone, with the result that the stump left after spontaneous separation is conical, the end of the bone projecting beyond the soft parts. ”

“ In superficial bones, such as the tibia, there is enlargement, and it may be possible to recognise egg-shell crackling, or unequal consistence of the bone, which is hard in some parts, and doughy and elastic in others. The disease may pursue an indolent course during months or years until some complication occurs, such as suppuration or fracture. ”

“ Such a simple mode of division does not occur in the more highly specialized cells of various tissues. If the karyokinetic action be not very vigorous, the nucleus may divide, but the cell body remains intact, producing the cell with two or more nuclei so commonly observed. Every cell reproduces its kind, spindle cells producing connective tissue; epithelial cells epithelium; and bone cells producing bone.
Repair of Wounds and Healing by Apposition. When a wound occurs, the cut edges immediately retract on account of the elasticity of the tissues, and the gap fills with blood and serum. ”

“ The limb is often enormously swollen and indurated. The gelatinous effusion beneath the periosteum speedily becomes organised, nodules of osseous matter project into it, and adhere to the surface of the bone frequently by a narrow neck; these increase in number, gradually assume a solid appearance: the bone is thus thickened, often to a very great extent. ”