The nature and etiology of bone disease in Kashmir ; The conservative surgery of long bones ; Necrosis of the lower jaw.

  • Neve, Ernest Frederic, 1861-
Date:
[1889?]
Catalogue details

Licence: Public Domain Mark

Credit: The nature and etiology of bone disease in Kashmir ; The conservative surgery of long bones ; Necrosis of the lower jaw. 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.

    19/50 (page 17)
    room for prolonged investigation and comparison of the relative value of the eviscerating operations and resection. This paper is a contribution to the subject. But I must here point out, that resections may not only be partial as far as the length of the bone is concerned, but also with regard to the circumference. In one sense, trephining may be a very modified resection. Trenching, where sometimes a strip of bone 4 or 5 inches or moro in length and i to 1 inch in breadth is removed, is a distinct partial resection, and it is in the performance of these operations that one is gradually led on to remove more and more of the diseased area and sometimes indeed of healthy new bone in order to get the best results. For the size of the actual bone cavity left after evisceration exercises great influence over the rate and completeness of cure. Some of the most satisfactory cases are those in which just a strip of bone is ieft posteriorly for the whole length of the shaft, as a support. The formation of new bone is a question of paramount im- portance in connection with resection. If the operation is done early and the periosteum treated gently, provided the patient is young, there appears not to be the slightest risk of failure in this respect. I have mentioned that the patient should be young. This is an important point. One may indeed lay down the rule that the younger the patient the more rapid and completely successful will the result be, while in patients of more than fifteen years of age one grows increasingly cautious in performing resection and reluctant to remove any but unmistakeably necrosed bone. It is right to mention that a case has been recorded in which false joint followed resection of a portion of the tibia.* In this instance the operation was done in 187(5 for extensive death resulting from abscess, and probably the periosteum was partially destroyed. In 1885 the boy was able to walk fairly well, but there was fibrous union of the contiguous ends of the tibia. Even with a great extension of the frequency of performance of resection there will still be a very large number of cases left * Murray. British Medical Journal, 1885, Vol.. 1, page 793.