A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . erficial or circum-scribed than under opposite con-ditions. That separation has beenaccomplished is known by themotion that can be communicatedto the sequestrum by a probepassed into the openings. This is sometimes better determined byintroducing two probes, one near each end of the sequestrum. Some-times the sequestrum is not movable, even when completely detached,because it is imbedded in the granulations on the inner surface
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . erficial or circum-scribed than under opposite con-ditions. That separation has beenaccomplished is known by themotion that can be communicatedto the sequestrum by a probepassed into the openings. This is sometimes better determined byintroducing two probes, one near each end of the sequestrum. Some-times the sequestrum is not movable, even when completely detached,because it is imbedded in the granulations on the inner surface of thesheath. If this condition is suspected a strong probe should be used toforce the sequestrum down upon the granulations until they are flattenedand the cavity enlarged. Motion can probably then be detected. Prognosis.—The prognosis in necrosis as to final restoration of theusefulness of the part is generally good, except in acute septic disease seldom extends beyond the epiphyseal cartilages, and,after removal of the dead bone, the sinuses heal, leaving, however,some deformity in contour. Death at times does occur in the early Fig. 124. FISTULA. Diagram of a transverse section, showing relationsof sequestrum, involucrum, cloaca and skin.(Gerster.) NECROSIS OF BONE. 333 stages, as, for example, in cases following acute septic osteomyelitis orperiostitis ; so also exhaustion from prolonged suppuration or pyaemiamay lead to a fatal issue. Again, death may result from secondaryimplication of other structures. This is illustrated by brain diseasefollowing necrosis of the skull, arthritis subsequent to disease of thepatella and laceration of the femoral artery by necrotic spicules fromthe femur. Pyaemia from moist necrosis is not uncommon ; but for-tunately this form of bone disease is quite rare. Treatment.—The indications in the first stage are to moderate ac-companying inflammation, by treating thoroughly the causative osteo- Fig. 125. Fig. 126. •
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