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NECROSIS OF THE DISTAL EPIPHYSIS OF THE RIGHT FEMUR

EDWIN F. HIRSCH, M.D.; EDWIN W. RYERSON, M.D.
JAMA. 1929;93(9):679-684. doi:10.1001/jama.1929.02710090019007.
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Certain chronic diseases of joints causing protracted mild but increasing disability and atypical clinical symptoms are now recognized as being due primarily to epiphyseal necrosis, usually of one of the bones articulating in the affected joint. Axhausen1 recently reported that an abundance of material available to him for examination had enabled the study of these lesions in all stages, and he expressed the belief that these epiphyseal necroses are bland anemic infarcts of the bone caused by mycotic embolic vascular occlusions. The organisms in these mycotic emboli, he stated, are rapidly destroyed by the tissues or never gain a foothold.

The chief objection to this view is the contention held by certain pathologists that anemic infarcts do not occur in bones because of the great vascularity of the marrow, but the skeleton as a rule is not subjected to careful postmortem examination. For this reason silent foci escape notice,

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