456 AN ADDRESS ON THE TREATMENT OF 



inch in diameter. For the shaft of a femur of an adult male, a piece like this, 

 about one-tenth of an inch in thickness, which I have had specially prepared 

 with a view to a case of ununited fracture of the femur which we expect to 

 operate upon in the hospital this week, is requisite, in order to resist with 

 certainty the enormous force of the great muscles of the thigh. The pieces 

 of bone which I hold in my hand were removed, in August 1881, from a case 

 of badly united fracture of the femur. The patient was a gentleman from 

 Rio de Janeiro. The fracture had occurred about the junction between the 

 middle and upper thirds of the bone ; and it had been so badly united that 

 the fragments overlapped very much, and also were at a considerable angle 

 with each other, so that the limb was extremety distorted, as well as much 

 shortened. Bloodlessness of the operation having been provided for by eleva- 

 tion of the limb and the application of an elastic tourniquet, I cut down from 

 the outer aspect of the thigh upon the seat of fracture. Then, with a periosteum- 

 detacher, I separated the soft parts from the place of junction of the fragments ; 

 and, in the next place, I went through the extremely laborious process of 

 cutting through the osseous union (which was of almost ivory hardness) parallel 

 to the axes of the two overlapping fragments. This having been at length 

 accomplished, and the soft parts still further detached, I found that I was 

 able not only to get the limb into a straight position, but also, by very moderate 

 extension, so to reduce the riding of the fragments that, b}^ sawing off com- 

 paratively small portions, I was able to bring their extremities into apposition 

 and appty my suture. This was done with wire of about this same thickness. 

 The limb was put up at first with a long splint. I need not enter into details 

 regarding the after-treatment ; but I may say this, that he was a weakly man, 

 and it was some months before absolutely firm union was obtained. It would 

 have been extremely embarrassing to have had the ends of the wire sticking 

 out from the wound all that time. On the contrary, it was a very great 

 comfort to have no occasion to think about the wire ; and ultimately he left 

 for South America, with a perfectly straight limb, almost of the same length 

 as the other, and, at the same time, with thoroughly firm union. 



But to return to the immediate subject of my communication. Ever after 

 my first case of ununited fracture of the olecranon, I was on the look out for 

 a fracture of the patella to treat on the same principle. Dr. Cameron, how- 

 ever, anticipated me. In October 1876, being now full surgeon in the Glasgow 

 Infirmary, he admitted a man with transverse fracture of the patella. He 

 treated him, in the first instance, in the ordinar}^ way, and dismissed him at 

 the end of eight weeks with a pretty short and strong ligamentous union. 

 Eleven days later, however, he reappeared, having ruptured the fibrous band 



