| OCR Text |
Show i RACTURED PATLLLA. rascrnasn PATELLA. the accident 01 an unwary movement, producing action in the muscles of the thigh. A long double neckcloth is twisted together, then laid over the knee above the upper portion of the patella; it hangs down on either side; take hold of the hanging parts of the cloth, and with the fore finger of the left hand, hook that which is held by the right, and with the fore finger of the right hand hook the cloth where it is held by the left, so as to bring them across under the knee: then bring the ends of the cloth over the lower part of the joint, and below the inferior portion of the patella, and pass them through their respective nooses, formed as described by the fore fingers, draw the whole tight, and then approximate the two circular turns of the bandage, which are above and below the knee pan, by finally passing the ends through the upper cirv the bone, the new-formed tendon runs over the articulating head of the thigh bone, this lever is lost. It is possible to make a perfect recovery, in cases of broken patella, by pro: dueing a close union betwixt the broken pieces in the way that I have described. It unfortunately the patella should be united by a long intervening ligament, we need not despair of bringing the muscles to accommodate themselves to this lengthening of their tendon. Often, though the thigh bone be remarkably shortened after fracture, yet the muscular action of the limb is by exercise restored to full power. So in this instance, by exercise, the shortened muscles become capable of still fur- -w..7 14.11 can r~"f‘~ "T" '"vuufirr ‘---'.-»-< . . cular, and fixing them there. We have now to inquire why there is so remarkable a lameness after the fracture of the patella, and why the patella of the other side is so apt to be fractured in a person who has once met with the accident. The sccond accident follows naturally from the lameness consequent on the first; and this lameness, which is so frequent a consequence of the fractured patella, proceeds from two circumstances. 1. The fractured pieces are not brought into accurate correspondence ; but owing to the imperfect relaxation of the quadriceps muscle, the upper portion is kept too high to be in contact with the lower, and instead of bone uniting the two parts of the patella, there is a long intermedi‘ate ligament, (such as I have represented in the annexed plate). One consequence of this is, that the muscles being allowed to remain contracted, they lose their power of giving a perpetual tension and support to the limb, and also of accommodating themselves readily, and with sulfieient strength to the necessary motions. 2. The patella, in its natural position on the top of the knee, being somewhat removed from the centre of the joint, bestows a power on the muscles, by eX~ tending the lever on which they act 3 but when, instead 01" ther contraction. 145 To facilitate this, Mr. Hunter recoup mended that the patient should seat himself on a table, and by giving motion to the leg, exercise these muscles, and that he ought to put a weight on the foot, to be increased as the power of the limb was regained. ' When the patella is fractured by a blow, as I have seen it by the kick of a horse, the connexions of the muscles with the joint, independent of the patella, keep it from being drawn up, as in the fracture I have already described. Here the injury to the joint is so great, that we cannot apply a bandage if it were required. We trust to the position alone, and are careful to bleed largely, and apply cold cloths so as to keep off inflammation. I have seen a very terrible accident follow the imperfect. cure of the fractured patella. The bone had united by It gament, and this ligament had incorporated with the skin in such a manner that it lost much of its pliancy. The poor man was carrying a burden and fell backward, the knee sunk under him, and the whole fore part of the joint was laid Open by lacerat ion. The case terminated in amputation ol‘ the limb. .» vmnr- Io -, |
