Fig. 213
Bony ankylosis of hip with deformity. (Ransohoff.)
When a joint is stiff bony ankylosis may be inferred. So long as there is any motion possible it is essentially of the fibrous type. The condition is one easy of recognition, and is seen in all degrees of completeness. In many instances joint fixation is accompanied by adhesions of tendons and tendon sheaths, while as time passes all the structures around a joint thus fixed become less movable and more stiffened. Even the patella may become firmly attached to the bony surface upon which it normally rests, and thus interfere with motion of the knee almost as much as though the femur and the tibia were alone involved. Occasionally one of the acute exanthems is followed by contractures of a joint, with or without actual joint lesions, by which when neglected distressing deformities are produced; such, for instance, as partial flexion and fixation of the knees, or such stiffening of the hips as to prevent the thighs from being separated. While in such cases stiffening cannot always be prevented, deformity at least can be if suitable measures instituted sufficiently early.
[Figs. 211] and [212], from Ransohoff, illustrate osseous union in the hip and the knee, while [Fig. 213] illustrates the deformity which may be produced by contractures and ankylosis at the hip.
The following tabular presentation of the types of ankylosis will perhaps convey the greatest amount of information in small space:
| Ankylosis, true and false | - | Peri-articular | - | Capsular | ||||||||
| Extracapsular | - | Tendinous | ||||||||||
| Tendovaginal | ||||||||||||
| Muscular | ||||||||||||
| Articular | - | Synovial | ||||||||||
| Cartilaginous | ||||||||||||
| Osseous | ||||||||||||
Murphy has prepared the following table of the types of arthritis which lead to some of these varieties, and which may be classed as follows:
| Arthritis | - | (a) Primary hematogenous fibrous arthritis | ||||||||||||||||||
| (b) Dry fibrous arthritis. Non-traumatic | ||||||||||||||||||||
| (c) Traumatic fibrous arthritis | - | With fracture into joint | ||||||||||||||||||
| Without fracture (contusion) | ||||||||||||||||||||
| (d) Suppurative | - | Hematogenous | - | Cryptogenetic | ||||||||||||||||
| Metastatic | - | Typhoid | ||||||||||||||||||
| Scarlatina | ||||||||||||||||||||
| Pyemia | ||||||||||||||||||||
| Gonorrhea | ||||||||||||||||||||
| Traumatic | ||||||||||||||||||||
| Extension | - | Osteitis | - | Tuberculous | ||||||||||||||||
| Osteomyelitic (infective) | ||||||||||||||||||||
| Peri-arthritis (phlegmon) | ||||||||||||||||||||
| Panarthritis | ||||||||||||||||||||
| (e) Ossifying arthritis (primary) | ||||||||||||||||||||
| (f) Static adhesive | ||||||||||||||||||||