EDITORIALS
of all
the
factors
will
appendage
patients
show
removed.
because
of
because
the
boon
feel
the
revulsion
with
amputation
against
remember
that
the restoration
of mankind-the
ground
make
219
ANNOTATIONS
of the
digit
the
best
primary
treatment
a remarkable
reluctance
later to have a stiff, livid, painful
and
This is an attitude
dictated
not only for reasons
of compensation
natural
opening
sentence.
Let us then
than amputation,
that
sometimes
AND
increasingly
of limbs
abilities
our
mutilation,
as
reconstructive
which
though
to feel
and
the
writer
has
useless
but
emphasised
in
his
surgery
includes,
as much
or more
not always
completely
normal
have
to grasp
with
our
hands
feet.
and
H.
to reach
and
to
OSMOND-CLARKE.
REFERENCE
GILLI5,
L. (1956):
Amputations
in Children.
Annals
of
the
Royal
OSTEOCHONDRITIS
The
recent
etiology
years
of
the
to light previously
differ
so widely
more
become
term
and
dissecans
literature
has
and
more
but it is usually
a portion
of the
that
may
or occupational
indeed
be the
of
19, 335.
England,
has
given
rise
condition.
conception
to
much
number
speculation,
of case
and
reports
Indeed
the manifestations
of the classical
lesion
diagnosis
can
not necessarily
of the
mechanical
condition.
Even
and
applied
bone,
extrusion.
in the knee
“
similar
concerned,
be properly
containing
of gradual
and
dissecting
in some cases-particularly
or
are
reported
it has
the
cause
cases
that
case
the
that the
surface,
differing
in
bringing
that
over-use,
sole
Surgeons
merely
serves
to indicate
a broad
similarity
between
one
fast criteria
can be laid down
as being
necessary
to justify
accepted
articular
widely
of
DISSECANS
an increasing
of the
accepted
apparent
dissecans
hard
and
attempts
to separate
by a process
There
can be no doubt
that
athletic
contained
unknown
features
from
the previously
osteochondritis
another.
No
diagnosis,
in which
osteochondritis
world
College
to any
separates
case
or
“
and
ankle-trauma,
factors
play
an
important
in these
cases
it is doubtful
part
and
whether
the lesion
can ever be properly
described
as a simple
osteochondral
fracture.
The fact that
the lesion
invariably
shows
itself on a convex
articular
surface
and never
on a concave
one,
although
it remains
unexplained,
is also a clear indication
that some mechanical
factor
must
underlie
the development
of the lesion.
Even when a constitutional
factor
is known
to exist,
as in bilateral
affection
of the elbow,
it is always
the dominant
right
affected.
However,
mechanical
factors
alone
are quite
insufficient
arm that
to explain
is more severely
the occurrence
of multiple
and often
symmetrical
lesions,
familial
and hereditary
cases,
and
with dwarfing
and endocrine
disorder.
White,
in this number
of the Journal,
patients
in whom
the multiple
with shortness
of stature
and
factors
may
determine
factor
is obviously
be an association
authors.
It is interesting
the
lesions
of osteochondritis
fairly convincing
evidence
joints
affected
to note
the
age
incidence
treatment,
or even without
treatment.
factor
seems
to be preponderant,
as
VOL.
39 B,
NO.
the
sites
predominant.
It is also interesting
with osteochondritis
of the spine
hip joints
may occur
in a young
child.
later in life. There
is a strong
tendency
involvement
of
in cases in which
and
1957
of the
that
which
in different
were present
in association
upset.
Local
mechanical
lesions,
but
the
constitutional
in White’s
case there
appears
to
has also been noted
by previous
cases.
Affection
of one
or
both
The lesion
is radiographically
identical
with those seen
to spontaneous
healing
of the lesion with conservative
It is also
shown
by
noticeable
multiple
the knee caps and familial
cases,
the
a single joint is involved.
There appears
2, MAY
dissecans
of endocrine
the association
records
three
that
joint
when
the
involvement,
constitutional
symmetrical
age incidence
tends
to be lower
than
to be a stronger
case for the operation
220
EDITORIALS
of some
constitutional
much
lower,
the onset
osteochondritis
and
without
With
factor
being
dissecans
any
regard
conservative
affecting
child,
older
why should
children
and
often
been
than
the
was
that
knee
once
and
excision
when
of the
after
detached
tendency
can
heal
fragment
arthritis
than
the
persistence
of irreparable
it would
and
adults
in whom
symptoms
The practice
of multiple
be quite
inappropriate
although
evidence
bone-graft,
not much
of healing
countersunk
great success,
carried
a loose
body
which
joint.
It is doubtful
children,
publicised.
of the lesion.
classical
site
which
are
as common,
on the
of one
or other
femoral
and
in a small
Used
An
hole
or fragments
medial
condyle
in which
condyle,
the
to the
crater
lies
restoration
of the
Smillie
has shown
that
it can be achieved.
It will,
limitations
of the method
can be defined,
but in the
to remind
us of the possibilities
of conservative
surgery.
suggestion
that
an extension
of the
bone
and articular
cartilage
is an interesting
consider
this as a practical
surgical
possibility
has been proved
experimentally.
principle
in many
cases
surface.
an
articular
fragmentation
excision
of the
they
describe,
in older
been
children
employed
case it can
is to use
Smillie
has
for
lead
to
a small
now,
with
by replacing
in the crater
in some other
part of the
the lesion
lies in the so-
intercondylar
on
and
even at a stage
This sort of
that
cases
has
a stage further
and is lying free
necessary
when
close
is inevitable,
and
Barbier
to the
fragment
articular
more
of repair.
There
are
to lead to symptoms
in the appropriate
alternative
procedure
in the
conservative
surgical
treatment
has already
become
detached
whether
such a policy
is really
called
just
in young
a
in a young
healing
of the lesion
in
In the past it has too
detachment
are minimal
or absent.
drilling
of a partly
detached
is
is complete
towards
by carving
it out,
remains
unbroken.
of Guilleminet
and
may be appropriate
incidence
By contrast,
spontaneously
inducing
means?
of the loose fragment
although
softened,
age
growth
is only justified
if it is clear that there can be no hope
the existence
of a crater
on the joint
surface
is less likely
subsequent
His
arises
increasing
not be directed
towards
by surgical
or non-surgical
separation
but
peg
commonly
If the lesion
of cartilage
and bone.
The recommendation
lesion
in the hip is the treatment
of choice
many
years,
radiological
or elbows,
and the
growth
is complete.
cause.
been
an
popular.
surgeons
have anticipated
detachment
when
the overlying
articular
cartilage,
surgical
occasions
elbow
before
joint
constitutional
there
has
our treatment
young
adults
accepted
ANNOTATIONS
in affection
of the
almost
invariably
evidence
of any
to treatment,
approach
AND
notch,
important
but
in other
weight-bearing
surface
is highly
cases,
surface
desirable
and
of course,
meantime
take some
time before
the
Smillie’s
contribution
serves
could
to the
lead
speculation,
but
until the possibility
use
of homograits
NORMAN
THE
JOURNAL
of
it would
be premature
to
of survival
of such a graft
OF
BONE
ROBERTS.
AND
JOINT
SURGERY