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Show .. ‘7?» .._- . -w.4 1412 ERACTURED PATELLA. rascmarn 1'ATELL.‘~.. 143 would rather trust to the general experience of the proios cul‘ar frame is brought into sudden and almost spasmodic ac- sion, than to my suggestion, he may take the following me- tion, the power of those muscles is inconceivably great. Again, the patella cannot be broken when the muscles pull directly in the line of the bone; that is, when the limb is straight; nor yet when the knee is so bent that the patella lodges betwixt the bones, and is supported by the condyles. But when the knee is moderately bent, and the patella is raised on the convexity of the lower head of the thigh bone, the muscles act at an angle with the ligament of the patella, and then the patella is broken across. The patient falls to the ground, and the surgeon finds that instead of the usual thod :- You extend the limb until by marking the relation of the trochanter major to the ilium, you find you have brought the bones into their due relation to each other. You then lay compresses above and on the sides of the troehanter; then a roller is put round the pelvis and thigh, so as to keep these compresses and the bone firm. (So far it may be well to do before laying the limb out on the inclined planes-I object to what follows, as inefficient). A long splint of wood is now to be put along the whole thigh, fixed at the upper part by havs ing the end pushed into the folds of a bandage or belt, which goes round the pelvis ; while to the lower part are attached bandages, which go round the knee and ancle, and which may be drawn so as to stretch the limb. OF THE FRACTL‘RED PATLLLA. prominence of the knee, the joint is flat, and he feels the greator portion of the patella drawn upward on the thigh, while the other part is still attached to the ligament, and the two condyies of the thigh bone, are prominent. Treatment-Let the surgeon avoid all motion in the limb, or at least bending of the knee joint, else there will be further danger of laceration. If the patient is to be carried home, in order to be quite safe, he has only to be carried sit- an. fracture of the patella, or knee pan, happens in conse- quence of a sudden and very strong action of the four muscles which are inserted into it while the knee is in that degree of flexion that the patella is raised upon the convex surface of the lower head of the femur. Sometimes the patient observes that the crack of the fractured bone was before he fell ting upright in a chair, with his leg extended. There is no occasion for a bandage to secure the upper portion of the patella,‘ from being drawn further up on the thigh. When the patient is laid in bed, we have to bring the fractured portions together: first, by position; secondly, by bandage. It wiil be manifest, that the leg is to be laid (in to the ground ; while, for the most part, deceived in the out opposition to the general rule) extended; so that the lower Cumstances, he supposes that in striking the ground, the knee pan has been fractured. It must, at first view, appear strange, that the patella can be broken by the mere force of the muscles! but two things are to be considered, the great massiness and strength of the muscles which operate on it, and the position of the patella. The body must be brought forward in the sitting pos- which may be called a quadriceps muscle, raise the whole ture, that the point of origin of the rectus from the pelvis, may incline towards the knee, and relax the quadriceps mus Cle. Or instead of the patient sitting in an uneasy posture, he may lie on either side, only having the hip joint bent, and the leg extended. When the extensor muscles of the leg, which are inserted into the patella, are thus to the utmost degree relaxed, the weight of the body, and are powerful in their ordinary action» pieces of the patella will have come into their natural posi« But when a man slips his foot, and I may say the whole mus- Hon. The muscles which operate on the patella, are the rectus, r, "3' "I‘ -"'~'»I€"-" .‘ .mick ,, portion of the patella may be raised on the fore part of the joint. the eastus extemus and internus, and the erureus. These A bandage must now be applied to guard them against Was-ft -, . |