448 SURGICAL APPLIED ANATOMY. [Chap. xxi. 



tuberosities. Such accidents are the result, in nearly 

 every instance, of great direct violence. Dr. Hutton 

 reports a case, probably unique, in which the spine of 

 tibia, the central part of the head of the bone, and a 

 considerable portion of the left articular surface, were 

 torn from the rest of the tibia. The anterior crucial 

 ligament was attached fco the fragment. The patient 

 had been wrestling while in a state of intoxication, 

 and had been heavily thrown. Madame Lachapelle 

 reports a case of separation of the upper epiphysis of 

 the tibia caused by traction during parturition ; but I 

 am not aware of any reported case of separation of 

 this epiphysis due to violence or under circumstances 

 other than this. 



The spongy tissue in the head of this bone and in 

 the lower end of the femur is, par excellence, the 

 favourite seat for myeloid sarcomata. 



In excising the knee-joint through an inci- 

 sion commencing at the back of one condyle, and 

 continued across the joint, just below the patella, to 

 the back of the other condyle, the following structures 

 are divided : Skin, fascia, patellar plexus of nerves 

 (formed by the middle and internal cutaneous and 

 the patellar branch of the long saphenous), bursa 

 patellae, anterior part of the capsule, ligamentum 

 patellae, synovial membrane, lateral and crucial liga- 

 ments, the superior and inferior articular arteries, 

 the anastomotica magna, and the anterior tibial 

 recurrent vessel. 



The incision over the inner condyle need not be 

 made so far back as to divide the internal saphenous 

 vein and nerve. In sawing the femur it is most 

 important that the exact inclination of the joint 

 surface of the bone be reproduced. If improperly sawn 

 the patient would be bow-legged or knock-kneed. The 

 rule, therefore, is that the saw be applied parallel to 

 the articular surface and perpendicular to the shaft. 



