American practice of surgery : a complete system of the science and art of surgery . Thus, for example, the epiphyseal ends of the long bones are the common seatsof the spongy exostoses (Fig. 178), while the eburneous outgrowths are usu-ally seen in relation to the skull. In general, they may be divided into two main classes: the fibrous or peri-osteal, which arise from the periosteum (or adjacent tissues); and the carti-laginous, which originate, as the name implies, from displaced bits of cartilage. The fibrous exostoses arise either from the inner surface of the periosteum(in which case the
American practice of surgery : a complete system of the science and art of surgery . Thus, for example, the epiphyseal ends of the long bones are the common seatsof the spongy exostoses (Fig. 178), while the eburneous outgrowths are usu-ally seen in relation to the skull. In general, they may be divided into two main classes: the fibrous or peri-osteal, which arise from the periosteum (or adjacent tissues); and the carti-laginous, which originate, as the name implies, from displaced bits of cartilage. The fibrous exostoses arise either from the inner surface of the periosteum(in which case they are connected with the bone from the beginning) or fromvol. in.—26 402 AMERICAN PRACTICE OF SURGERY. the middle layer, becoming attached to the bone later (disconnected exostoses).In .-till other cases the new-growth begins with ossification in a tendon or apo-neurosis, and then soon afterward becomes attached to the hone. The cause is in any case obscure, hut in a large proportion inflammation isan important factor. Exostoses often come alter trauma —as, for example, after. FlG. 178.—Spongy Kxostosis of the Lower Part of the Fibula. (Original.) a fracture—or they appear near the scat of a diseased hone. In this connectionmay he mentioned the ossification observed in the deltoid, in the adductors,and in the quadratus femoris; such osseous growths,however, do not come underthe heading of true exostoses. The most common sent of eburneous exostoses is the skull. They arise onthe vertex at any point; indeed, all the bones of the skull have been reported ashaving been the seats of such growths. They are either flat, sessile tumors,slightly raised, or they are cone-shaped, with a broad base. Sometimes they TUMORS ORIGINATING IN BONE. 403 are even tuberous, with more or less of a pedicle. They vary in size as wellas in shape, in time attaining large dimensions, but they are of very slow of them arise from the external periosteum, but they occasionally startin the
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