The morbid processes met with in bone originate in the same way and lead to the same results as do similar processes in other tissues. The structural peculiarities of bone, however, and the important changes which take place in the skeleton during the period of growth, modify certain of the clinical and pathological features.
Definition of Terms.—Any diseased process that affects the periosteum is spoken of as periostitis; the term osteomyelitis is employed when it is located in the marrow. The term epiphysitis has been applied to an inflammatory process in two distinct situations—namely, the ossifying nucleus in the epiphysis, and the ossifying junction or metaphysis between the epiphysial cartilage and the diaphysis. We shall restrict the term to inflammation in the first of these situations. Inflammation at the ossifying junction is included under the term osteomyelitis.
The term rarefying ostitis is applied to any process that is attended with excessive absorption of the framework of a bone, whereby it becomes more porous or spongy than it was before, a condition known as osteoporosis.
The term caries is employed to indicate any diseased process associated with crumbling away of the trabecular framework of a bone. It may be considered as the equivalent of ulceration or molecular destruction in the soft parts. The carious process is preceded by the formation of granulation tissue in the marrow or periosteum, which eats away and replaces the bone in contact with it. The subsequent degeneration and death of the granulation tissue under the necrotic influence of bacterial toxins results in disintegration and crumbling away of the trabecular framework of the portion of bone affected. Clinically, carious bone yields a soft grating sensation under the pressure of the probe. The macerated bone presents a rough, eroded surface.
The term dry caries (caries sicca) is applied to that variety which is unattended with suppuration.
Necrosis is the term applied to the death of a tangible portion of bone, and the dead portion when separated is called a sequestrum. The term exfoliation is sometimes employed to indicate the separation or throwing off of a superficial sequestrum. The edges and deep surface of the sequestrum present a serrated or worm-eaten appearance due to the process of erosion by which the dead bone has been separated from the living.