FRACTURE 
“When the limb is thortened; the trochanter major does 
not projec as in the natural ftate, — is drawn SS and" 
backward: toward the crifta of arte 
as oO n 
thie eee of a circle, of which the neck 
radius. hes obfeurity attending this 
a eee will be in elas to the 
nearnefs athe eae to the head of the b 
almoft all inftances, the toes are ae outward by t 
the ation of the mufcles. Paré, Petit, and Default, how- 
ald have oe with — in which the foot. has been turned: 
aps, fometimes happen that. the 
aoe of. he in will epee this pofition of the foot, 
particularly when the patient is old, debilitated, or in a 
faint condition. 
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formi a evils ae been imputed to the deftruction 
of the neck of the bone ; a circumftance which was thought o 
t - The truth is, that lamenefs does not 
ri Englif practitioners. 
In this country, fraétu 
are oh Sg seal treated in the bent pofition ; though t there are 
e furgeons, who a the limb in the ftraight alae 
with common fplints 
" Fradures of jhe Patella, Rotula, or Knee-pan. 
The patella may be broken. by external violence, or by a 
very powerful ee uiras of the extenfor mufcles of the legs 
which are inferted in 
Authors: {peak of eae, piers and longitudinal 
fractures ; ; but, although the two firft cafes are univerfally 
acknowledged, few writers admit the pollbilty of the laft, 
unlefs as ‘a confequence 0 of gun-fhot woun 
has been remarked by- Hevin, that a tranfverfe 
silaeghe of i patella i is moft frequently occafioned by out- 
more or lefs in a ftate .of 
fexion 3.at whic t bone is fituated on the arti- 
cular pee of the ‘thigh-b ‘one, with its two extremities 
tg ea tia chat pate ee i ear alge fabjeee to 
ures of the neck-of the i lasagne 
the accident, an ‘account of the e trong: exertions which they 
are under the neceflity af making in their various forced 
attitudes. Ruyfch mentions a cafe,-in his: Vs 
ir. in which the kneespan was broken by the powerful 
contra@tion of the mufcles. He fays, “ Vilitavi cum wh - 
oe Petri eum egret -virum fatis robuftum, m, qui e pon 
defcendens, in a ré ceciderat ; imo pede. lubrico, re- 
fiftens tamen be an tuit, in terram non fecerit pro-: 
lapfus; fed ab ilé ehiftentié tranfverfim fra@a eft ejus pa- 
te ae one A a evidenter ut inter utramque partem locari- 
atu Sy. un 
bone Hes even: n this way into pe pieces. 
Gian happens shat patients fuppofe the injury a 
pata sogrife ie all, whether this is the ‘fa@t o 
as they” pene um ble d down at the time of the acci- 
ie ; and the fur a without proper inquiry, would not 
be led to think that the aceident is fo often the mere e 
of. the contraction of the mufcles as it really is. The cele- 
brated Camper firlt obferveé the fact, that very often the 
fall is the eonfequence of the fr Sore and not’ the fracture 
of the fall. By fome caufe o 
oder n {argeons are oo. well aopeed of. the Sara a 
of the patella being etl commonly fraétured in the 
ner, that we 
c 
| particularly ftriking ‘and convincing. - 
foldier, who broke his patella i in aithing a lick at a ferjeants 
whom, however, he miffed. - be . fica : oS 
ingly curious: a man, on.wh per- 
formed, was feized, while in the 0 amie ae the 
étel Dieu, with mo — om a mufcles; and 
the. extenfors of his legs,: igs ed with. fuch 
power, that, in has te of the ipediataes they broke 
both the knee 
n the ca aes funder confderaton, the - ab of the fries 
tured bone are alwa r lefs ted from eac 
ther. This. s beat is rae oie by the ae ee of 
the extenfor mufcles of the leg, the ftrong tendon of whicli 
‘is implanted into- the upper part of the patella, and even 
covers all the fore part of this bone in the form of an apo- 
Mi ace the feparation i is to the extent: of four 
Mer eX e 
Su a writers 
z o be Solel not to rupture 
the a in gueftion, in examining t 
t ov ught to! be underftood, that the interfpace betwee the 
anda afcent and defcent « of the upper: and lower fi agmient. 
1@ upper piece ag be drawn a confiderable way upward 
by the aGtion of the. fo cruraeus, and vafti mufcles ; but 
the = wer one : capable of being atted upon by no mufcle; 
and ¢ a moved from the other by the flexion of the 
yr leg. "Tt j on this account that the feparation. is ia when - 
the limb i is exterided, the upper fragment Being then the - 
only one which can be difplaced. When the knee is bent, 
however, the lower fragment moves downward, at the fame 
time 
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