458 AN ADDRESS ON THE TREATMENT OF 



with fibrous tissue, fascial and periosteal, mingled with them, constituting 

 so firm a mass as to make it quite impossible for the two fragments to be 

 brought into contact. The clots having been completely cleared away from 

 between the fragments and from the interior of the joint, I applied a common 

 bradawl in the middle line of the patella, drilling each fragment obliquely so 

 as to bring out the drill upon the broken surface a little distance from the 

 cartilage. Pretty stout silver wire was then passed through the drilled openings, 

 and the fragments thus strung upon it were pushed firmly home, and so brought 

 accurately into apposition. Before they were brought together, however, an 

 arrangement w^as made for the drainage of the joint. This was done on the 

 same principle in all the cases that I have to record, and I may therefore 

 describe the matter once for all. A pair of dressing-forceps, with the blades 

 closed, were introduced from the wound made into the anterior part of the 

 joint to the most dependent part of the outer aspect of the articulation. The 

 instrument was then forcibly thrust through the synovial membrane, the 

 fibrous capsule, and the fascia, until the point of the forceps was felt under 

 the skin. An incision was then made with a knife through the skin upon the 

 end of the dressing-forceps, so as to allow it to protrude. The blades of the 

 forceps were then expanded so as to enlarge the opening which they had made 

 in the deeper structures without risk of causing haemorrhage. The drain was 

 then seized in the forceps that protruded through the wound, and drawn into 

 the joint. The ends of the wire were now twisted together, and the twisted 

 ends brought out at the wound, which was closed with sutures and a small 

 drain inserted. I need hardly say that in this case, as in Dr. Cameron's, anti- 

 septic treatment was employed throughout. It is unnecessary for me to enter 

 into details as to the progress of this case. We have here the temperature- 

 chart for as long as it was thought worth while to have it recorded, and you 

 will see that it indicates, after a little temporary disturbance immediately 

 after the operation, an entirely afebrile condition. The wounds healed with- 

 out any suppuration. At the end of eight weeks, the wire was removed by 

 an incision through the cicatrix. Eight days later, the wound made for the 

 removal of the wire had healed. At the end of ten weeks from the operation, 

 the patient was allowed to get up, and, though no passive motion had been 

 employed, he could move the limb freely through an angle of about thirty 

 degrees. Two days later he was discharged, and, unfortunately, nothing has 

 been heard of him since. I saw him once in a cart a few days after he was 

 dismissed, but I have not been able to learn any further tidings of him. This, 

 I believe, is the first instance of a recent case of fracture of the patella being 

 treated by wire-suture antiseptically applied. 



