Modern surgery, general and operative . .). Ununited Fracture of Patella.—A semilunar in-cision is made about the fragments, the convexitypointing up or down (this avoids the prepatellarbursa), or an incision is made in the long axis ofthe limb, over the middle of the space between thefragments, from well above the upper fragments towell below the lower piece. The soft parts are re-tracted, but the periosteum is undisturbed; eachfragment is bored (Fig. 433, i) in one or two places;the surfaces of the fragments are cut square throughsound bone with a saw; all old reparative materialis cut away;
Modern surgery, general and operative . .). Ununited Fracture of Patella.—A semilunar in-cision is made about the fragments, the convexitypointing up or down (this avoids the prepatellarbursa), or an incision is made in the long axis ofthe limb, over the middle of the space between thefragments, from well above the upper fragments towell below the lower piece. The soft parts are re-tracted, but the periosteum is undisturbed; eachfragment is bored (Fig. 433, i) in one or two places;the surfaces of the fragments are cut square throughsound bone with a saw; all old reparative materialis cut away; the wires are passed through the per-forations, twisted, cut off, and hammered down (Fig. 433, 2). If the bone-frag-ments cannot be approximated, it may become necessary to incise the musclearound and above the patella or partially to separate the tuberosity of the tibiaand bend this process upward. A small drain is inserted above the bone,the wound is sutured, aseptic dressings are applied, and the limb is put upona Macewen Fig. 433.—Wiring of the pat-ella: I, Fragments cut and cleanedand the wires passed; 2, wirestwisted and hammered down uponthe bone (after Barker). Aspiration of Joints 695 Trevess Operation for Caries of the Lumbar and Last DorsalVertebrae, with Abscess in the Psoas Magnus or Quadratus Lum=borum Muscle.—The patient lies upon his left side, with the knees drawn upand a sand-bag under the left loin. The surgeon stands behind the patient(Barker). An incision is made at the outer border of the erector spinae mass,reaching from the last rib to the iliac crest and going down at once to the lum-bar fascia. The lumbar aponeurosis is opened, the erector spinse muscle isretracted inward, and the anterior portion of the erector spinae sheath is in-cised. The quadratus lumborum muscle is next cut, and then the anteriorleaflet of the lumbar aponeurosis is slit. The abscess is thus reached andopened and tuberculous pus flows out. The abscess-cavity is irr
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
