The diagnosis of traumatic separation of the epiphyses / by John Poland.

  • Poland, John, 1855-1937.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis of traumatic separation of the epiphyses / by John Poland. 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.

    4/14 (page 2)
    paired usefulness that may ensue in the limb in a few years, and point out all that may occur in spite of the most careful and skilful treatment of the case. Simple separation of an epiphysis from the shaft, with more or less displacement, may be tolerably easy of recog- nition by the ordinary rules of surgery, but it is the compli- cated cases and cases of detachment of part only of the epi- physis, with fracture of the diaphysis, that may mislead and throw us off our guard. The latter may also be combined, though rarely with dislocation of the epiphysis. To make the subject as clear as possible I shall remark upon the chief points in the diagnosis of epiphysial injuries collectively, at the same time describing several of the more common separations, giving examples. Let us take six points, placed in the order of their impor- tance, or more correctly their trustworthiness. 1. Age of the patient. 2. Mobility corresponding to an epiphysis. 3. Displacement at an epiphysial line. 4. Modified crepitus. 5. Character of displaced diaphysis or epiphysis. 6. Joint frequently intact. /. As to Age.—These injuries can only occur, as a rule, in patients below 21 or 23 years of age, before the epiphyses have become united by bone to the shaft. A few instances have been recorded beyond this age, but I am inclined to put down these exceptional cases, like those occurring in young infants, as the result of some diseased or at any rate altered condition of the bone. Contrary to the generally accepted views, I believe trau- matic separation of the epiphyses, especially those of a simple character, to be comparatively rare in young children, and this I shall presently explain. When we come to closely ex- amine into this question of age it will be found that the ep- iphyses of certain bones are liable to be broken off at par- ticular periods. I was greatly struck with this fact when examining the specimens of epiphysial separation in the museums of London and elsewhere. Taking for example the lower epiphyses of the femur, which according to museum specimens is more fre- quently affected than any other—out of fourteen specimens,