Observations on the angle of the neck of the thigh-bone ; Loose bodies in the joints / by Professor Humphry.

  • Humphry, George Murray, Sir, 1820-1896.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the angle of the neck of the thigh-bone ; Loose bodies in the joints / by Professor Humphry. 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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    be dated from the time of their dislodgment, and their origin would be attributed to the force which had dislodged them. Thus the in-egular nodule of bone (Museum of College of Surgeons, 1931), one side of which is bare and the other covered with substance which looks like cartilage, and which presents no indications of its ever having formed a part of articular surface, and no broken part to show that it separated from any pedicle, was removed by Mr Bar- well from a retired army surgeon, aged 43, subject to rheumatic arthritis. Two months before it was removed he struck his knee sharply, and the next day he found a loose body in the joint. He had no synovitis or pain. He then missed a bony lump which he had noticed previously over the inner condyle. So also the large loose body (in the same museum, 1935), nodulated on one side, flat on the other, partly bony and partly cartilaginous, which presented no evidence that it ever formed part of the normal surface of a joint or was ever pedunculated, and which was excised from a man, aged 40, and presented by Sir William Fergusson, was detected after a severe twist of the knee. A young man in Addenbrooke's Hospital sprained his right knee while boxing, was carried home, and kept his bed for a fortnight. He then perceived a loose substance in the outer part of the joint. After a month he could get about pretty well. As he experienced inconvenience from the substance, he came into the hospital and it was removed. I am informed that it showed no sign of having been detached from an articular surface, and pre- sented the ordinary appearance of a loose cartilage, being about the size and shape of a strychnine nut. The joint was, to all appearance, quite sound before the injury. Instances of the discovery of these bodies soon after injury are also given in Hey's Surgery; in one case there were two in the same knee, the fact of there being two preclud- ing the idea of their being the direct result of injury. It is well known that in rheumatic arthritis these cartilaginous and osseous bodies are very liable to form in the synovial villi, which com- monly enlarge in this disease; and these may be found to have become detached in great numbers. They also form in the synovial membrane, and possibly in the subsynovial tissue, and often in close proximity to the articular cartilage. When thus situated they may grow into contact with, or encroach upon, the thickened, outgrowing, nodulated, and lipping margins of the articular cartilage so often met with in rheumatic arthritis. In this borderland between cartilage and synovial membrane it is not always quite easy to tell in which of these structures the osseous bodies were formed ; and of two observers, one will judge that they have originated in continuity with the articular cartilage and are in process of separation from it, while the other will conclude that they have originated in the synovial membrane, and are in process of encroaching upon or coalescing with the abnormally projecting articular cartilage. The latter, which I believe to be the more common, may be often proved by noting the manner in which the several stages of growth in the membrane with approximation to the cartilage are evidenced at different parts in the same specimen. The edges of the