American practice of surgery : a complete system of the science and art of surgery . ter is somewhat later in appearing than the former. Ossifica-tion does not appear in the patella until the third year of life. Even up to theend of the third year a considerable thickness of cartilage still surrounds theossific centres in the femoral and tibial epiphyses. The femoral epiphysis in-cludes the condyles and the articular surface of the bone anteriorly. Thetibial epiphysis includes the tubercle of the tibia. The disc of cartilage whichseparates the femoral shaft from its epiphysis persists until th
American practice of surgery : a complete system of the science and art of surgery . ter is somewhat later in appearing than the former. Ossifica-tion does not appear in the patella until the third year of life. Even up to theend of the third year a considerable thickness of cartilage still surrounds theossific centres in the femoral and tibial epiphyses. The femoral epiphysis in-cludes the condyles and the articular surface of the bone anteriorly. Thetibial epiphysis includes the tubercle of the tibia. The disc of cartilage whichseparates the femoral shaft from its epiphysis persists until the twenty-firstyear. The plane of the cartilaginous disc is transverse to that of the axis of thefemur, and is situated immediately below the adductor tubercle, which may betaken as a surgical landmark in locating it. (Consult also the article on TheEpiphyses and their Radiographic Interpretation/ page 578, Vol. I). epiphyseal cartilageof the tibia, which persists until the twenty-first year of life, lies in a plane at right angles to the axis of the tibial shaft; it. Fig. 2S7.—Section through the Knee Joint of a Child Nine Years of Age, Showing the Epiphyseal Car-tilages. (Original.) lies for the greater part immediately above the tubercle of the tibia, but dipsdownward anteriorly to include that tubercle. In Fig. 287 these two epiphy-ses are seen in a child nine years of age. The growth in length of the limb de-pends largely upon the persistence of these cartilaginous discs, and if, becauseof disease or of injury, these cartilages are destroyed, there is great interferencewith the growth of the bones, and marked disparity will result in the length ofthe two limbs, the degree of shortening depending, of course, upon the age ofthe child at the time when the cartilage is destroyed. The cancellous bone, of which the epiphyses are composed, has a thick cover-ing of articular cartilage both in the child and in the adult. In Fig. 288 the struct-ure of the adult joint
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