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Fig. 25.-Case 6. Lateral view shows excessive anterior curvature of the shaft of the femur. This could be felt also. The legs were of the same length. The child walks with a waddling gait which could not be attributed definitely to the affected femur.
Fig. 26.-Case 6. At the third year the upper femur still shows some enlargement. The neck of the femur forms almost a right angle with the shaft. while the lower extremities of the bones show rachitic enlargement.
Fig. 27.-Case 6. Lateral view at the third year shows the curvature still present though less marked than in the observation made at the eighteenth month. The legs are noted to be of equal length, tendency to knock-knee present, and also flat-foot upon the affected side. However the child walks without limp, and the motions of the thigh are normal in all directions.
No. 1 from infant that died at the fifth
week, No. 3, at the eighth week. Both femora of both cases were dissected out after death. It is interesting to note how slight is the shortening in each fractured bone. present also.
In bone 3, there is rotatory deformity
Fig. 29. Lateral view of same. Both fractures would be considered in very unfavorable position in an adult patient, but in the new-born such position would almost certainly result in bones free from deformity after the first year, and so might be looked upon as satisfactory for these cases. The cartilagenous lower epiphysis with its ossification nucleus is well shown.
cases is that angular deformities of the femur following birth-fracture if uncorrected result in curvatures probably permanent. Although these curvatures produce no measureable shortening of the affected leg, and no disability or change in gait, they may, in time, exert some unfavorable influence upon the limb mechanically, as at the hip joint, the knee or the foot. No case has been observed beyond the third year, and while the curvatures in the oldest cases have shown some slight tendency towards improvement, it is improbable that the deformity will ever disappear as do corresponding curvatures of the humerus in infants. If the effort to overcome the angular deformity usually present when the fracture first comes under treatment be successful these curvatures do not result.
When alignment of the fragments has been obtained the over-riding or shortening can be ignored, as may also the lateral displacement accompanying it. Half an inch shortening in a bone four inches in length is admittedly excessive, but is of little importance in the adult when the same bone has become four or five times this length, even if nature does not make up the deficiency during childhood.
By J. R. LOSEE, M. D., Pathologist.
OSTEOCHONDRITIS is one of the most characteristic lesions of congenital syphilis occurring in the early weeks of life. It is known clinically as pseudoparalysis on account of the listless and motionless attitude which the infant assumes. The lesion is observed at the junction of the diaphysis and the epiphysis of nearly all the long bones. The structures most commonly involved are the lower extremities of the femora, upper extremities of the humeri and the ribs, however, in some cases all the long bones show lesions typical of the various stages of the disease. Inasmuch as the loss of function of the extremities is the most important symptom there was considerable difference of opinion as to the location of the lesion. Pollak and Zappert on the one hand believed that it was due to a lesion of the central nervous system or of the peripheral nerves, while Parrot considered that the inflammatory process which he constantly observed in these cases at the epiphyseal junction was the direct cause of the symptoms. This latter view has since been confirmed by more recent observers.
In 1899 Gilbert stated that syphilitic osteochondritis occurred in about 5% of all cases of congenital syphilis. Fabre and Rhenter in a later article published the results of 67 autopsies on the new born and found 31 cases of osteochondritis in 40 cases which gave a definite or a very probable history of syphilis. Of 27 cases from whom no specific history was obtained 3 showed positive signs of osteochondritis and 2 were doubt