On the healing of aseptic bone cavities by implantation of antiseptic decalcified bone / by N. Senn.

  • Senn, Nicholas, 1844-1908.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: On the healing of aseptic bone cavities by implantation of antiseptic decalcified bone / by N. Senn. 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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    outer side of the bone to a distance of one and one-fifth inches. The upper terminus of the inflammatory process was an infiltration of the cancellated tissue with pus, necessitating an excavation of a cavity the size of a walnut. The exposure of the sinus in the hone made it neces- sary to chisel a gutter in an oblique direction from within outward and downward one-third of an inch in width and one and one-fifth inches in length. A number of small sequestra were removed and the granulations scraped out with a sharp spoon. Disinfection and packing of the cavity with decalcified bone chijjs in the usual manner. Catgut drain and deep and superficial sutures. As the dressings were saturated the next day they were removed. Suppuration followed the third dressing, with the result that four weeks after the operation some of the bone chips, show- ing the corroding action of the granulations, escaped. At this time some of the bone chips could be seen in the cavity embedded in granula- tion tissue. The subsequent coui’se demonstrated that the chips which -were in close contact with the walls of the cavity were retained while the central por- tion of the packing was eliminated. When suppuration ceased the cavity had nearly closed, and the gutter was filled two-thirds of its depth with vigorous granulations; after another thorough disinfection the remaining cavity was again implanted with bone chips, and in the course of another four weeks the entire surface has healed, leaving only a very slight depression on the surface of the bone. The clinical history of this case shows that the cavity was aseptic from the beginning, and that the reparative process had progressed in a satis- factory manner for two weeks, when accidental infection occurred at the time the third dressing was made, Avhich for a time arrested the healing process and resulted in the elimination of the central portion of the bone packing. As soon as suppuration had ceased and an aseptic con- dition of the granulating surfaces could be secured, secondary implanta- tion was done and was followed by complete success. Case IX. Reflection of knee-joint; large tuberculous cavity in head of tibia.—Female, aged twenty yeai’S, was treated at the Milwaukee Hospital for tuberculous arthritis of knee-joint during the year 1888. The disease had existed for several years, and, in spite of tlie usual treat- ment, continued to grow worse. The knee-joint was greatly distended by what appeared to be masses of granulation tissue. As the head of the tibia presented two well-marked points of tenderness, it was surmised that the disease had taken its starting-point in this bone, and that the knee-joint had become involved secondarily. Typical resection of knee- joint. The section made through the tibia revealed three small tubercu- lous cavities. Condyles of femur healthy. A careful inspection of the sawed surface of the tibia revealed at one place osteoporotic bone, and exploration at this point di.sclosed another deep-seated tuberculous focus, the removal of which resulted in the formation of a cavity the size of a walnut. This cavity was packed with bone chips before the resected surfaces were brought in apposition. Complete healing under two dress- ings. Firm bony union in the course of two months. Good use of limb and no relapse to date. That the filling of the cavity with decalcified bone chips expedited bony consolidation, there can be no doubt, as with the removal of the implanted chips the osteoporotic material invaded the