FRACTURE, 
time that the upper one is' drawn upward, and, confe- 
— the feparation muft in this ftate be the moft ex- 
afides the feparatien: of. ‘the two pieces of a fraftored 
patella, there are other fymptoms pointing out. the nature of 
the accident. When the limb is extended, the upper frag- 
i with the lower one, 
alfo attended ah an’ inability to walk, acute 
pain, anda ae ‘fwellin of tlie joint. 
Inftences have occur | in which the tendon of the ex- 
pnd mufeles -— wee ruptured jut above the patella; but 
ore comm: cident is rupture of the neat of 
fe: patella itfelf, ‘below this 
ake ave red by the ancients, in 
e patella, was very unfavourable. 
‘Ambroife ee remarked that no perfon could oe e008 
n accident of this kind, without a — of lamenefs. 
Fabricius Hildanus, in * {peaking of a 
Be who fra€tured the knee-pan, obferves, “© Ab initio, et 
arte curatus fuiffet xger, nihilomimis a dolores 
acutiffimi aliaque fy mptomata fupervenerunt. em 
Tore reliquis isque fedatis’ fympton ole, conv valu quidem, 
fed claudicatio ac fumma imbecilitas totius cruris fecuta eft, 
ita ut non nifi maxima cum. difficultate ambulare, et shied 
afcendendo fublevare poffit.’ 
Is it true, that the See -and ee of the limb 
proceed, as edd ee from the 
inal from 
° 
J 
‘who dee 
magn 
pedire idemus enim, ut plurimum in reliquis offium 
fraCturis, nifi contufio offis et perioftei fuerit maxima, na- 
turam tam decenter et — connectere offa, ut raro 
a fracture vettigi 
an author in the. Fac) desea Méthodique remarks, 
if eee Hildanus had only paid attention to the impro- 
per proceedings, followed at that time in the treatment of a 
broken patella, he would foon have difcovered the true caufe 
of the lamenefs, ia was formerly a frequent confequence 
of the accident. the fragments of the bone were not 
put into contact, a is arge cartilaginous mafs was formed be- 
tween them which, not having the firmnefs of bone, per- 
It is true, hss in the old practice, the knee-j Bie was 
kept. rs long without motion, that an anch Hiylofsdom metimes 
enfued ; but, now that practitioners adopt the plan of -ha- 
bituating the articulation to gentle motion, after a certain 
period has elapfed, this confequence i is hardly ever’ known. 
a. 
Wander-Wiel, ste Pott, and fome other writer's, 
aintained t rine, that a moderate afetieee be- 
tween the two reas f a. broken patella was advan- 
t » and conducive to the perfe& functions of the 
knee-joint after the cure. Certain it is, that, in the miajority 
ef cafes, the fragments are united by means of a ligamentous 
fubitance, inftead of But the opinion of the pre- 
coiing authors feems to be by.ne means accurate. The 
; confiderable 
he indi 
forty years of | 
patella is fometimes repaired by callus, ide any ill ef. 
fects ; and Default always found the joint more perfe@, the 
maller the interfpace between the fra ae, When the 
were apart, he always found that the patient could not eae 
up rifing ie or pafs over irregular eu without 
allo, “— vomprelling the fame mufcles with a roller el 
over the thigh, from the groin to the knee. 
Secondly, The lower tragment of the paces is to be 
ut as near to the pelvis as poffible, by extending the 
leg. 
Thirdly, The upper fragment is to be pufhed down into 
contact with the lower one, and fixed in this pofition witha 
comprefs and a few turns of a roller. 
‘ourthly, ‘The extended pofition of the limb is to be per- 
manently maintained, b 
ies tie a to lie on his 
back, and enjoin him not to hae his knee in the leaft. The 
eg is then to be al extended, and the thigh fomewhat 
bent on the pelvis. pofture is then to be preferved, 
by laying pillows under ne heel, calf of the leg, and thigh. 
The ime dispels elvis fhould alfo be properly raifed 
forward, fo tee aor me the anterior inferior fpinous 
procefs of oe lium nee ur 
the limb. 
A: long fplint, lined with a foft pad, is next to be applied’ 
all along the outfide of the limb ; or one, fomewhat fhorter,. 
may be put under the thigh and. deg. This {plint, which 
will. feeurely Prevent all flexion of the knee, is to be fixed’ 
on sae ar 
It is 
atient. 
