Identifier: principlespracti1872hami ()
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a. The patella is usually broken by falls upon the knee ; but occasion-ally by the action of the muscles alone, as when one attempts to savehimself from falling. The fracture is, in most cases, transverse, but occasionally the line offracture is oblique or longitudinal; sometimes it is comminuted. Thediagnosis is, in general, easily made, although in many cases of trans-verse fracture it may be difficult or impossible to discover crepitus.Ordinarily the original displacement of the upper fragment is aboutthree-quarters of an inch, but in some cases it is much greater. The treatment consists in elevating the limb upon a well-cushionedinclined plane, so as to relax the quadriceps femoris, and then securingthe upper fragment in place by a roller; after which the whole mustbe supported upon the splint by a roller extending from the foot to thegroin. In the accompanying drawing this last-named roller is only ap-plied to the lower portion of the leg, the dressing being incomplete. Pig. 112.
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Apparatus for Fractured Patella. The patella, having been broken transversely, usually unites by ashort ligament. If, however, the ligament is not more than half orthree-quarters of an inch in length, the limb will be as strong as if thefragments had united by bone. The cure cannot generally be consider-ed completed under six or eight weeks; but, to prevent anchylosis, pas-sive motion should be given to the joint as early as the fourth or fifthweek. Great care must be taken, while employing passive motion, notto rupture the ligament; and when the patient is permitted to leave thebed, he must be cautioned against bending the knee forcibly or bear-ing great weight upon it. I have known the new ligament to beruptured in several cases by attempts to rise from the sitting posture,and in others by bending the knee over the side of the bed. It hasbeen observed also that the refracture, or, to speak more correctly, that FRACTURES OF THE TIBIA. AND FIBULA. 307 the rupture of the newly formed l

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