FRACTURE OF THE PATELLA 465 



out the wire, and without our feehng that the wire was in a very secure form, 

 we should not have thought of permitting. Four weeks after the operation, 

 the wound was healed. The knee was then bent to an angle of forty degrees. 

 Eight weeks after the operation, the patient was discharged, having been for 

 a considerable time before (I have not got it exactly recorded when) allowed 

 to walk about the ward, and w^alking well. You will observe, gentlemen, 

 that this is my most recent case. He has not had the same time for improve- 

 ment that the others have had. 



[The patient was now introduced, walking up the room without the 

 slightest limp. He said he was getting on 'first-rate'. He found the leg 

 continue to get stronger, and he was able to move it better. He noticed that 

 it was getting stronger every week ; he might say every day.] 



I confess I am surprised to see how complete a patella this man has, con- 

 sidering how extremely small the lower fragment w^as. There must have been 

 considerable new osseous formation from the periosteum, because here we 

 feel the central part of the wire, and yet between that and the lower border 

 there is what appears to be a substantial lower fragment connected with the 

 upper one by osseous union. Now we may say he has a perfect patella. 



These, gentlemen, are all the cases of fracture of the patella on which 

 I have operated, and I consider it fortunate that I am able to bring before 

 vou six out of the seven. 



I should like now to say a few words as to the method of operating. The 

 wire employed should be, as I have said, pretty stout, about one-sixteenth 

 of an inch in diameter. I have not found it needful to use more than a single 

 suture of such wire. It is applied in the vertical plane, in the course of the 

 longitudinal incision over the middle of the bone ; and in recent cases no 

 dissection of the soft parts from the patella is necessary. It seems important 

 that the cartilaginous surface of the bone should be left quite smooth, or. in 

 other w^ords, that the fragments should be exactly at the same level at their 

 lower part. We cannot be perfectly sure, when we drill, that the bradawl 

 will come out exactly at a corresponding point on the two surfaces. Supposing 

 that on one side the instrument should have come out too far down, it may 

 be into the cartilage (as at d, Fig. 2) instead of a little above it. \\'o do not 

 regard that at first, but pass the wire through each drill-hole the moment the 

 drill is witli drawn, and then on that side on which the hole has come too far 

 down, by means of the bradawl, we simply chip away a little of the material 

 that is above the wire until the wire comes to be in a position exactly opposite 

 to the hole on the other side, leaving a gap below, as indicated by the dark 

 shade at d. This is a perfectly simple matter ; at the same time, it might 



