472 



ON THE TREATMENT OF FRACTURES OF 



It occurred to me that, although such a use of the wire did not seem Hkely to be 

 very satisfactory as a permanent arrangement, yet it might probably be adopted 

 with great advantage as a temporary expedient ; and that, after the quadriceps 

 had been gradually stretched by the use of the limb in the position so produced, 

 the fragments might by a second operation be brought into contact, and might 

 then be wired in the usual way after paring the opposed surfaces. The first 

 case in which I put this idea in practice was a sufficiently testing one. The 

 patient was a young woman of very stout and heavy build, who had fractured 

 both patellae, one of them four years, the other three years before she consulted 

 me. The fragments were, in both limbs, considerably separated ; and in the 



Leg 



B 



Th/g/? 



Fig. I. 



left, where the bone had been injured four years previously, the separation was 

 so great (about 5 inches), and the upper fragment, at the same time, so very 

 small, that I at first despaired of being able to do anything. 



But on the right side, the upper fragment being of good size and the separa- 

 tion more moderate, I determined to give the plan a trial. I made two short 

 longitudinal incisions {A B and C D) over the two fragments (shown in dotted 

 line, Fig. i), and having exposed them by a little dissection, drilled two holes 

 in the upper one, and passed through them, from without inwards, the ends of 

 a piece of the usual stout silver wire, so that, when the ends were pulled upon, 

 the middle of the loop of wire would press upon the surface of the fragment, 

 thus (Fig. 2) : — 



Fig. 2. 



Anter/or 



Si/rface 



of the 



Upper Fragment 



Next, passing into the lower incision a blunt instrument (a broad raspatory), 

 I detached from the front of the femur the soft parts lying between the incisions, 



