REMARKS ON THE TREATMENT OF FRACTURES 

 OF THE PATELLA OF LONG STANDLNG 



{British Medical Journal, 1908, vol. i, p. 849, and Lancet, 1908, vol. i, p. 1049.] 



Shortly before I retired from practice I devised a method of dealing with 

 fractures of the patella of long standing which gave very satisfactory results. 

 I failed to publish it at the time ; but a surgical friend having asked my advice 

 in a case of that kind, I wrote for him a detailed description of the procedure, 

 preserving a copy of my letter, which I venture, even at this late period, to 

 reproduce. 



Fisher's Hotel, 



Pitlochry, Scotland. 



September 15th, 1895. 



My dear Dr. — , 



I should have written to you long ago regarding Miss 's case, had I not 



known that you could not deal with it till you had returned home after vour 



autumn holiday in Europe ; Mr. having given me your address in London 



up to the 15th inst. The limb is no doubt useful as it is ; but it is very far 

 from being as strong as we should wish to see it ; and assuming, as I do in your 

 case, that the surgeon can look with confidence to an aseptic condition of the 

 wound, I think an endeavour should be made to improve it. Indeed, there 

 is good reason to believe that it will be made as serviceable as ever. I doubt, 

 however, whether you will be able to bring the fragments together without some 

 special mode of procedure. When you visited my wards in King's College 

 Hospital, now several years ago, I showed you a young man on whom I had 

 operated on account of a fracture of the patella of long standing with considerable 

 separation of the fragments, where I had attained my object by means of free 

 division of the quadriceps extensor muscle. This, however, is a pretty severe 

 measure, and involves, at the best, more or less weakening of the nuiscle and 

 a long cicatrix. 



Since that time I have greatly improved on that practice, and have 

 succeeded without touching the quadriceps by proceeding in two stages. The 

 idea was suggested to me by a case published by Dr. Lucas-Championniere. of 

 Paris, who, being unable to get the fragments into apposition, wired them 

 together nevertheless, and left the wire in as an adjuvant connecting medium. 



