FRACTURE OF THE PATELLA 459 



My next case occurred two years later. William T , a coal-porter, 



thirty-seven years of age, was admitted on the 13th of December, 1879. He was 

 a muscular man. The patient slipped on the 9th of December, while carrying 

 a sack of coals, and felt something give way in one knee. On endeavouring 

 to rise, he found himself unable to do so. On admission into the hospital, 

 the right patella was found fractured transversely, the interval between the 

 fragments being about an inch. There was a considerable amount of effusion 

 into the joint. On the 15th of December, that is to say six days after the 

 accident, I proceeded to operate, making a longitudinal incision, as in the last 

 case, about two inches long, over the patella. The lips of the wound being 

 held apart with blunt hooks, a hole was drilled in each fragment in the median 

 line. Stout silver wire was passed, and secured by half-turns. A drainage- 

 tube was introduced, as in the last case. And here, again, there is no need 

 for my entering in detail into the reports. We have before us the temperature- 

 chart. For the first fortnight after the operation, there was what we ma}- 

 call an absolutely afebrile state. During the rest of the time of his residence 

 in the hospital, there were two accidental elevations to 1005°, but nothing to 

 indicate anything serious. The wound healed, as in the last case, without 

 any suppuration. Six weeks after the operation he was allowed to get up. 

 Eight weeks after the operation an incision was made through the cicatrix 

 for the removal of the wire, the loop of which was cut, and the wire withdrawn. 

 On the 23rd of February, that is a fortnight later, the bandages which had 

 been previously applied to the leg were removed, and it was found that he 

 could bend the limb to a right angle ; he could walk well, and was able to 

 kick. On the 22nd of February, 1883, this patient showed himself. We then 

 took the following notes : ' The patella seems perfecth^ natural, except a trifling 

 irregularity of outline on one side. It is evidently osseously united. The 

 movements of the joint are perfect, from complete flexion to extension. He 

 can kick vigorously. He says the joint is just as trustworthy as ever. He 

 frequently carries a weight of 220 lb. for upwards of 100 3'ards, and he walks 

 without the slightest limp.' 



[The patient was now introduced and exhibited to the Society. He said 

 his limb was as good as ever, and that it never failed him. J 



I have not seen the man since the time I have referred to. Except for 

 the linear cicatrix, no one would be able to tell that this patient luul had 

 anything wrong with his knee at all. 



The next case was one of ununited fracture. The patient. Joseph R , 



aged twenty-two, was admitted into the hospital on the 27th of September. 

 1880. He is a soldier, and stated that, on the 3rd of June of that year, while 



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