. The diseases of children : medical and surgical. wards and backwards. In suchcases the inner border of the tibia is verystrongly marked, forming a prominent ridgesomewhat spirally twisted, ending below atthe convexity of the forward curve, and aboveat the inner side of the internal tuberosity{fig. 42). In many cases, especially in thoseof long standing, whether this inner border iswell marked or not, there is a prominentspur-like buttress of bone developed below the inner tuberosity at theinsertion of the internal lateral ligament ; this spur, the existence ofwhich was, we believe, first poi
. The diseases of children : medical and surgical. wards and backwards. In suchcases the inner border of the tibia is verystrongly marked, forming a prominent ridgesomewhat spirally twisted, ending below atthe convexity of the forward curve, and aboveat the inner side of the internal tuberosity{fig. 42). In many cases, especially in thoseof long standing, whether this inner border iswell marked or not, there is a prominentspur-like buttress of bone developed below the inner tuberosity at theinsertion of the internal lateral ligament ; this spur, the existence ofwhich was, we believe, first pointed out by Mr. Clement Lucas, is pro-bably the result of ossification of the ligament as a result of strain andirritation, somewhat as in the case of riders bone and other instancesof bony overgrowth at the attachment of greatly used muscles. Theprominent ridges, as stated by Mr. Noble Smith, are most marked whenthe disease is arrested and the stage of hyperostosis has come there is a flat surface of bone running up from the spur to. Fig. 42.—A case of severe Rickets,showing most of the commoner de-formities, as well as dwarfing fromSynostosis. Rickety Defo^nnities 215 the inner condyle of the femur (Macewen) ; in severe cases this is verystriking, and the spur reaches down far below the direct insertion of theligament. Two other conditions associated with these deformities requirenotice : one is that the patella in severe cases of knock-knee tends to rideoutwards upon the external condyle, and even to be dislocated quite to itsouter surface during flexion of the limb. This is the result partly of deficientsize of the external condyle, and partly of the bony curves, so that thequadriceps, acting in a straight line, does not make traction in the axis of thebones. The patella may also sink so deeply into the intercondylar notchin flexion that its position may be marked by a depression. The other con-dition referred to is the direction and arch of the foot. In knoc
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Keywords: ., bookauthorwrightgageorgearthurb, bookcentury1900, bookdecade1900
