FRACTURE OF THE PATELLA 461 



that he could walk with a stiff knee, whereas he could not walk at all on 

 admission, I hardly ventured to hope for anything better. However, on the 

 22nd of February, 1883, he presented himself, when the following report was 

 made : ' The patella is perfectly natural, except a little irregularity of the 

 two borders opposite the seat of the fracture. The surface is quite smooth. 

 There is no interval between the fragments. There is evident osseous union. 

 The degree of flexion is increasing. He can bend to an angle of 60°, and 

 extend again completely. He laid aside his stick last summer, and returned 

 to his work as a gardener seven months ago. He can do anything except 

 kneel. In getting over a paling, he has to throw the leg over in a partiallv 

 extended position. He walks with a barely perceptible limp.' We may now 

 say that he walks with no limp at all. 



[The patient was introduced and exhibited. He could now bend his knee 

 nearly to a right angle, and said that he was on his legs all da\', and was quite 

 equal to his work as a gardener.] 



The great interest in this case seems to me to lie in the improvement that 

 has occurred without any passive motion on the part of the surgeon, and as 

 a mere result of the natural actions of the limb ; from such a very rigid state 

 of things as there was when he left the hospital to the condition of mobility 

 which we now witness. 



The next case was also one of ununited fracture. The patient, Martha 



F , aged forty-three, was admitted on the 5th of November, 1S80, on 



account of an accident which had happened eight weeks before, when she felt 

 something snap in her knee, while trying to save herself from falling. She was 

 unable to walk or move the joint, which quickly swelled up to a large size. No 

 splints had been used, and no treatment of any kind employed. On admission, 

 there was fullness over the knee, and a transverse fracture of the patella to be 

 discovered in the middle of the bone. The fragments were separated one inch. 

 There was fluid in the joint, as indicated by fluctuation. On the 12th of 

 November, I operated as in the last case, paring away the flbrous material 

 between the fragments, and refreshing the osseous surfaces with cutting pliers. 

 The fragments were then drilled obliquely in the middle line, and brought into 

 apposition by means of a suture of stout silver wire. This, however, could only 

 be done when the limb was raised high into the air so as to relax the quadriceps, 

 she being a stout woman, with powerful muscles. Of course, antiseptic dressing 

 was employed ; and, as was done in all these cases, the limb was placed in 

 a trough of Gooch's splint, witli the upper end oblique, corresponding to the 

 line from the tuberosity of the ischium to the great trochanter, and the lower 

 end excavated in the form of a horseshoe, while the horns of the horseshoe 



