Perhaps no bony lesion has caused so much difference of opinion in
this profession as tubercular conditions of the spine, bones and
joints and I wish it understood that in the following discussion, it
is not my desire to reopen the argument. My observations have been
of cases treated both osteopathically and by fixation, in private
practice and institutional work. And I have come to the conclusion that
the fixation method of treatment is absolutely always indicated. In
general the pathology and etiology of all tubercular bone conditions
is the same. It begins as a tubercular infection of the spongy tissue
of the epiphysis, the first change being a local hyperemia of the
portion involved, followed by one of three courses: the diseased focus
being absorbed and a spontaneous cure resulting; it may extend to
the periphery of the bone and break through the periositum and empty
itself there by abscess formation; or most commonly it may extend to
the joint, which becomes involved through attendant injury. Repair is
brought about by the formation of fibrous tissue probably arising from
the layer of non-tuberculous granulation tissue which grows in and
replaces the tuberculous tissue. Also the replacing material may become
calcified and encapsulated. A fibrous or bony ankylosis may result from
this process of repair.
The vulnerability of growing bone accounts for the frequency of
tubercular bone disease in children as compared with adult life.
Injury not only causes a local predisposition to the disease, but it
favors its progress when it is once established. About seven-eighths
of the cases of this trouble occur under fourteen years of age, more
especially when the vertebræ or hip-joint are involved. The knee and
ankle joints as well as the elbow and shoulder joints are more often
diseased in later life. While the inherited predisposition is very
direct and positive in twenty-five percent of the cases, the acquired
predisposition is of most importance since it includes lessened
vitality due to poor food and imperfect hygienic surroundings. As
to the distribution of the disease the vertebræ are most commonly
affected, followed closely by the hip and knee joints, and then in the
order of frequency the ankle, elbow, shoulder and wrist joints.