Necrosis of Femur: Operation: Spontaneous Fracture: Amputation: Recovery

Progress.?The wound went on discharging much as before, but about three weeks later much pain being complained of, it was found that the femur had spontaneously fractured. Operation.?After a delay of some weeks, owing to the unwillingness of the patient, the thigh was amputated at the middle about 3 inches above the seat of fracture. The operation was performed under the spray, and subsequently the wound was stitched with silkworm gut, dressed with iodoform, and covered with a large muslin bag containing sawdust (carbolized). The wound was dressed every second or third day; and in spite of an old sinus and some bare bone, it healed by first intention with but a few drops of pus ; and the sinus itself shortly afterwards closed. Remarks.?At the time of the first operation I thought that probably a sequestrum still remained enclosed by the massive callus. On examining the limit after its removal the cause of the prolonged suppuration and of the fracture was seen. As the result of prolonged ostitis the medullary canal had become plugged, and by the dense osseous formation the nutritive supply cut off from a portion of the bone ; part of this necrosed and