The treatment of fractures . unless the occupation can be conducted witha leg held stiffly at the knee. The functional usefulness of thelimb and not anatomical considerations should be the chief crite-rion in determining the result following fracture of the patella. Ifa man can earn his living as before the accident without local dis-comfort or hindrance, he possesses a useful limb. It makes littledifference if there is a slight separation of the fragments or a sug- PROGNOSIS AFTER EXPECTANT TREATMENT -5 ?*> r* 333 gestion of a limp or slight atrophy of the thigh and calf muscles ;these con
The treatment of fractures . unless the occupation can be conducted witha leg held stiffly at the knee. The functional usefulness of thelimb and not anatomical considerations should be the chief crite-rion in determining the result following fracture of the patella. Ifa man can earn his living as before the accident without local dis-comfort or hindrance, he possesses a useful limb. It makes littledifference if there is a slight separation of the fragments or a sug- PROGNOSIS AFTER EXPECTANT TREATMENT -5 ?*> r* 333 gestion of a limp or slight atrophy of the thigh and calf muscles ;these conditions are all to be accepted as part of the irreparabledamage, and are trivial. In nonoperative cases the union isusually fibrous, although it may be bony. The interval betweenthe fragments may amount to five or six inches. The approxi-mation of the fragments of the patella is not evidence of strength,for the fibrous bond of union may be much narrower than thefractured surface and very thin, and thus easily ruptured. The. Fig. 469.—Double fracture of patella without great Fig. 470.—Transverse fracture of separation of fragments (X-ray tracing). patella, showing straps in position to hold fragments (X-ray tracing). usefulness of the limb after fracture of the patella is notdependent upon any one factor, either the kind of union orthe extent of the separation of the fragments of bone. Thereare usually no adhesions of the upper fragment to the femur ;but injury to the bursa under the quadriceps may causetroublesome adhesions upon the anterior surface of the flexion is a common result, but there is often limita-tion of active extension. There almost always remains a littlejoint stiffness, despite both massage and active and passive mo- 336 FRACTURES OF THE PATELLA tion ; this, unless due to fibrous adhesions, disappears majority of cases of fracture of the patella under carefulnonoperative treatment will secure a useful limb. A patellaonce fractured a
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectfractur, bookyear1901
