68 
does so, whilst the patella, tibia, and condyles 
of the femur sink towards the ham, and are 
drawn upwards behind the broken extremity 
of the shaft of the os femoris, which is thrown 
forwards.” He adds that falls from a great 
height on the feet or knees have been the usual 
sources of this accident.* In most of the cases 
already met with, and described, of oblique 
fracture of the lower extremity of the shaft of 
the femur, the direction of the obliquity was 
from above downwards, and from behind for- 
wards, and the pointed extremity of the broken 
bone was consequently directed downwards and 
forwards ; but the pointed extremity has been 
seen towards the popliteal space. In Sir 
Charles Bell’s lectures on the thigh-bone which 
he has published, there is an engraving of a 
very remarkable case, which appears to us to 
have been an oblique facture of the femur near 
the knee-joint, in which the pointed extremity 
of the superior fragment presented towards the 
sae space.t About twenty years after the 
ne had been fractured, the patient, in jump- 
ing down from a chair, felt something snap, 
and very soon after a pulsating tumour formed, 
which was discovered to bea popliteal aneurism. 
The direction of the course of an oblique frac- 
ture may be various ; that downwards and out- 
wards is the least likely to be followed by 
dangerous consequences. 
3. Oblique fractures of the os femoris into the 
knee-joint, detaching laterally the condyles, are 
not very uncommon accidents; they may be 
known by the great and sudden swelling of the 
joint by which they are accompanied, by the 
great degree of lateral motion which can be 
communicated to the limb, by the crepitus 
which can be felt, and by the obvious deformity 
with which they are attended. 
It is sometimes the inner condyle, and some- 
times the outer, which is detached from the 
shaft; and in these cases the cavity of the 
synovial membrane of the knee-joint is always 
opened into by the fracture. The following 
case presents a good example of an oblique 
simple fracture, which detached the outer con- 
dyle of the femur from the shaft of this bone. 
Ganet Doyle, xt. 45, was admitted into the 
Richmond Hospital under the care of Dr. Hut- 
ton on the 27th March, 1839. He stated that 
about ten minutes before his admission he was 
Standing ona double ladder about four feet from 
the ground ; the ladder gave way under him 
suddenly, and he fell with it, the right limb 
having been engaged between two of the steps. 
During the fall he was sensible of being bruised 
below the knee by the steps, and of something 
“ cringing” in the lower part of the thigh; im- 
mediately after the fall he found the limb quite 
werless and was unable to put it under him, 
umefaction of the knee and lower part of the 
thigh took place instantly and to a great extent. 
On examination the outer condyle was found 
to move and grate against the inner through the 
centre of the joint; no breach of continuity 
* Sir A. Cooper on Dislocations, 8th edition, 
plate xv. 
t Fig. 3, plate iy. 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
edge obliquely by the callus which had un 
could be detected between the inner cond; 
and shaft of the bone. The femur, as the 
tient endeavoured to stand, was directed do 
wards and inwards, and the tibia downw 
and outwards, so that the junction of # 
two bones at the knee-joint formed an ok 
angle salient internally. There was consider 
enlargement of the femur in the situat 
the fractare for several inches above the k 
joint, and on measurement there was shortel 
of the injured limb for half an inch. By mak 
extension, and by pressing the condyles tow 
each other, the natural form of the limt 
restored. No fever nor constitutional di 
ance arose, and at the end of the fifth w 
passive motion was recommended. W 
man leh the hospital the external app 
of the joint was very nearly natural, 
that thé peaalla had been elevated! whittal 
the fracture. When this bone was moved aen 
the trochlea of the femur, a roughness was 
ceived to exist on the corresponding surfe 
and a sensation of something grating was ¢ 
veyed to the fingers of the examiner. 
was some shortening of the limb, which « 
still remained more inclined inwards towa 
the knee-joint than natural, and the movem 
of flexion was limited. . 
Sometimes an oblique fracture occ 
through the lower part of the femur into” 
joint, which detaches the inner condyle. 
prognosis in these cases of simple oblit 
fractures of the inner and of the outer o 
dyle of the femur, so far as life is concer 
does not appear, from what we have seen 
them, unfavourable ; but we Oe ae I 
examples of what may be a Ss 
fiaceacti of the lower enirebilag the femu 
that is to say, a transverse fracture of the lo 
extremity of this bone, combined with a y 
tical split from the transverse fracture do 
through the trochlea into the outercondyloid fos 
of the femur, in which the is is gener: 
unfavourable, even when the fracture is uneo 
bined with any wound in the integume 
Mr. Chelius, of Heidelberg, shewed — 
Smith and the writer, in August 1837, 
specimens of T fracture of the lower extrei 
of the femur. In the first case, the en 
nature of the accident was unknown to Mr. C 
lius. Violent inflammation set in in the ki 
joint and the whole limb, causing the death 
the patient. In the second case be ecogni 
the nature of the injury early, and amputa 
in the thigh saved the patient In such ca 
to decide at once whether amputation s| 
immediately resorted to or not, becomes a 
critical and often a very urgent question. 
the first opportunity be lost, the constituti 
symptoms attendant on the local inflammat 
set in so speedily, and ran to such a heii 
that a second seldom offers ; the two follow 
examples, however, should caution. us agai 
deciding hastily on immediate Mp 
cases of simple fracture, in which the cavity 
the knee-joint is implicated, because, altho 
in the first case the femur was broken in 
great number of fragments, the inflammé 
i 
at 
100 
