Hip disease in childhood : with special reference to its treatment by excision . also depends upon how much thehead of the femur has been allowed to press upon the pelvis. It is very rare to find any attempt at a new formationof bone while the disease is progressing, while, afterremoval of the upper end of the femur, new bone may-be rapidly formed {Fig. 32); in this, of course, the hipresembles other joints. This rapid formation of new boneafter excision is a strong indication for that operation, inthat it shows that nature is unable to begin repair untilthe disease is removed. Professor Sayre
Hip disease in childhood : with special reference to its treatment by excision . also depends upon how much thehead of the femur has been allowed to press upon the pelvis. It is very rare to find any attempt at a new formationof bone while the disease is progressing, while, afterremoval of the upper end of the femur, new bone may-be rapidly formed {Fig. 32); in this, of course, the hipresembles other joints. This rapid formation of new boneafter excision is a strong indication for that operation, inthat it shows that nature is unable to begin repair untilthe disease is removed. Professor Sayres views of blood blister or local sub-chondral extravasation are wanting in anatomical proof,though such extravasation very probably does occur inconjunction with bruising of bone. 32 ON HIP DISEASE IN CHILDHOOD. As an illustration of subsynovial extravasation, I havebeen able, through the kindness of my friend ProfessorA. H. Young, to insert the accompanying sketchtaken from an old woman who fractured the upperpart of the shaft of her femur, and died shortly after. Fig. From a Case of Extra Capsular Fracture of the Femur— a, a, a, Lines of fracturerunning through the trochanter. B, Subsynovial_ extravasation of blood, c, c, Patchesof degenerated cartilage from early osteoarthritis. (From a drawing by Prof. A. ) A well-marked circumscribed patch of blood effusion isseen beneath the synovial membrane at the lower partof the joint, and this, together with blood extravasationinto the cavity of the joint, is the condition found inacute traumatic synovitis at its earliest stage. It is easyto understand both the pathology and result of suchan inflammation. It begins in the synovial membraneimmediately over the blood effusion and involves the jointdirectly. It simply requires a subsidence of an acuteinflammation of an elastic structure, like synovial tissue,and a reabsorption of a little effused blood to restore thejoint to its normal condition, This process differs ver
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