BY E. D. TELFORD, PROFESQOR OF SYSTEMATIC SURGERY, UNIVERSITY OF MASCHESTER.
WHILST i t is hardly pmsible to add anything useful to the very completc review of this disease by Lawford Knaggsl and the brilliant monograph of Dawson and Struthers,2 the following case seems worthy of record, not only on account of its long history and the very gross changes which appear in the bone, but also because it shows the formation of hyaline cartilage in considerable masses. This formation of hyaline cartilage in osteitis fibrosa is rare, and to this feature I have not been able to find in a search of the already very extensive literature anything more than the scantiest reference. B l o ~d g o o d , ~ referring t o cysts in osteitis fibrosa, says, " i n a few of thcse eases, here and there, islands of cartilage are found ". Elmslie4 states that cartilage occurs in small patchcs ; " it may be hyaline, but is more often fibrous ".
CASE REPORT.
HwroRY.-The patient was a woman, age 34 years, who came to the Manchester Royal Infirmary in June, 1930, begging for the amputation of her left leg, which she said was useless and painful. She stated that she was well until she suffered a fracture of the left thigh bone twenty years before. This fracture does not appear to have been radiographed, and after treatment it united well. Two years later she noticed a swelling of the shin bone, and found that the limh was becoining shorter than its fellow. This condition grew gradually worse until the left lower limb was short by no less than fire inches.
02; ExAMIhTATIos.-The limb presented a striking picture ; the shortening of five inches was found to lie entirely in the femur, the left thigh being stunted, wasted, and marked by deep transverse creases of redundant skin. The tibia was of normal length, but was uniformly enlarged in a fusiforni fashion reminiscent of the lower portion of an Indian club. Movements of the knee-and ankle-joints were normal, but the range of the hip-joint was slightly limited in all directions, more especially in abduction. The patient used the limb in walking, but only with difficulty and for short distances ; she complained of constant aching pain.
A routine examination showed that the patient was otherwise healthy. No focus of sepsis was to be discovered; the Wassermann reaction was negative. The hlood-calcium was normal, and in her thin and very easily palpated neck there was no sign of any thyroid or parathyroid enlargement.
REFERENCES.