AFFECTIONS OF THE BONES.
• Fracture's.
The fractures which are seen in the foatus may be produced in utero, or may result from traumatisms occurring during delivery. We shall only consider the first variety. Intra-uterine fractures are due to a de fect of ossification, to the non-union of the osseous masses, developed from the different centres (occurring particularly in bones of the head), to the separation of epiphyses, this separation depending on an inflammatory process, or a non-union of the diaphyses with the epiphysis, or to congeni tal rachitis. They may be caused by some traumatism sustained by the mother, which may leave no trace on her body. These fractures will be, of course, more readily produced where there exists already a primary de fect of ossification, or where there is less amniotic fluid. Almost always the extremities are the parts involved, and the thigh frequently, since its situation exposes it unfavorably; whereas the head, from its form, its situation or its engagement in the superior strait, usually escapes. The actual displacement, which is almost always seen in these cases, is the result of muscular traction, which, however, has not prevented union. Can these lesions be produced in the uterus in healthy bone, without external injury ? This seems at least doubtful to Spiegelberg, who admits, however, that in these cases, there may have been a protruding promontory and prolonged compression of the head or of other parta against it. Some cases of fracture of the cranial bones have been seen after natural labor in women who had pelvic deformity.
The prognosis is generally not grave. These fractures heal rapidly, unless from the influence of complications, gangrene occur. In some cases, however, they are caused by lesions of which traces are found at birth, in the form of pareses, atrophy of limbs, which show that there have been lesions of the nervous trunks, or inflammation, terminating by atrophy or sclerosis.
Cranial fractures, accompanied by hemorrhages, by concussion or by cerebral contusions, are most often fatal. If these last injuries are es
coped, the infants may recover from the fractures. Concerning the tor sions, the forced flexions, the general compression of the fcetus, they may be caused, considering the little space the fcetus occupies, by either an internal pressure exercised on the fo3tus by uterine or peri-uterine tumors, by deformity of the pelvis, by insufficient liquor amnii. Hohl and Con rad have collected a certain number of examples.
Luxations.
Concerning luxations, the etiology is obscure. They may be ascribed to an anomaly of development of the articular cavity, which, in conse quence of causes to-day still unknown, manifested itself first, not at the normal point, but at some other point of the iliac bone. It is curious that the greatest number of these observations have been in female fcetuses. Fehling believes that these depend on the fact that the flattened portion of the iliac bones was extended. In this connection it is necessary to cite the coxalgia observed by Bird, Broca, Morel Lavalle, Padieu, and the carious cases of ankylosis, by Bird, Richaud, Joulin; of ankylosis with hydrocephalus, by Becourt; and of gibbosity with or without hy drocephalus by Joulin, Moutons, Nivert.
Spontaneous Amputation& Under the name of intra-uterine amputations, spontaneous amputations or congenital amputations, are designated certain defects of conforma tion, characterized by total or partial absence of one or more extremities. Duplay, holding rightly that among these defects some are due to failure of the normal evolution of the limbs, an arrest of their development, others due to the action of some mutilating agent, which cuts them off as with the surgeon's knife, designates them as congenital amputations. The first, considered under teratology, group of ectronthliens (Geoffroy Saint-Hilaire), we shall not consider here. The second directly con cern the obstetrician.