A treatise on orthopedic surgery . thestunted limbs. The head is large. The face is flattened, thenose sunken and the skin may be thickened, the chest presentsa pigeon-like distortion, and the extremities of the bones appearto be generally enlarged. The hands and feet are short andbroad and the joints seem relaxed. In some instances the backis curved into a rigid kyphosis or scoliosis, and restricted motionor apparent fixation of many of the joints may be present.^ Etiology and Pathology.—These cases were formerly sup-posed to be instances of intrauterine rhachitis. Chondrodys-trophia is not,
A treatise on orthopedic surgery . thestunted limbs. The head is large. The face is flattened, thenose sunken and the skin may be thickened, the chest presentsa pigeon-like distortion, and the extremities of the bones appearto be generally enlarged. The hands and feet are short andbroad and the joints seem relaxed. In some instances the backis curved into a rigid kyphosis or scoliosis, and restricted motionor apparent fixation of many of the joints may be present.^ Etiology and Pathology.—These cases were formerly sup-posed to be instances of intrauterine rhachitis. Chondrodys-trophia is not, however, the result of a disturbance of nutrition;it is due apparently to a congenital defect or interference withthe development of the cartilaginous skeleton beginning atdifferent periods of intrauterine life, the apparent enlarge-ment at the joints being due to formation of periosteal bone atthe diaphyseal extremities. Rhachitis is characterized by thick-ening about the epiphyseal cartilages and by delayed ossifica- FiG. Cretinism in infancy. tion. In chondrodystrophia, on the contrary, there is atrophyof the epiphyseal cartilages. On section of a bone the shaft isseen to be thickened, stunted, and irregular in outline. Theepiphyses are often of normal size and consistency but the con-necting cartilage is irregular and atrophied. Chondrodystrophia is sometimes seen (Fig. 341) in a verymild form; the appearance of the child suggests rhachitis, butthe stunting of the growth is greater than is ever the result ofrhachitis of corresponding severity. —Cretinism may cause a similar dwarfing of thestature, and may be combined with chondrodystrophia, but the ^ Eoos, Zeits. f. klin. Med., vol. xlviii. Schirmer, Cent, f. cl. u. Chir., N. 10, 1907. 528 OETHOPEDIC SUSGEEY. symptoms of mental deficiency that accompany cretinism arelacking in this affection (Fig. 342). Treatment.—The treatment of chondrodystrophia consists inregular massage and manipula
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