. Manual of operative surgery. Fig. iioi.—{Morris.)a, Fat; b. Opening in synovial membrane behind crucial ligament leading into inner half of joint; membrane reflected off crucial ligament; d, cut end anterior crucial ligament; e, post, crucialligament; /, oblique popliteal;ligament; g, quadriceps; h, synovial sac; i, tendon quadriceps; j, patella;k, bursa; /, condyle femur; tn, patellar synovial fold; n, fatty cushion; o, bursa; p, tibia. (B) Separation of Lower Femoral Epiphysis.—Step i.—As the knee-jointis usually unopened by the injury, endeavor to avoid penetrating it. FigureII
. Manual of operative surgery. Fig. iioi.—{Morris.)a, Fat; b. Opening in synovial membrane behind crucial ligament leading into inner half of joint; membrane reflected off crucial ligament; d, cut end anterior crucial ligament; e, post, crucialligament; /, oblique popliteal;ligament; g, quadriceps; h, synovial sac; i, tendon quadriceps; j, patella;k, bursa; /, condyle femur; tn, patellar synovial fold; n, fatty cushion; o, bursa; p, tibia. (B) Separation of Lower Femoral Epiphysis.—Step i.—As the knee-jointis usually unopened by the injury, endeavor to avoid penetrating it. FigureIIOI shows the normal extent of the synovial sac. The obstacle to reduction. Fig. 1102.—Separation of lower femoral epiphysis. {Scudder.) is no single band or obstruction, it is the retraction and tension maintainedby the fascia, ligaments, and muscles of the thigh upon the tibia. This retrac-tion is so great that the tibia is held crowded against the lower end of the upperfragment, and prevents the replacing of the epiphysis (Scudder). 924 SPECIAL FRACTURES Step 2.—^Make an external longitudinal incision freely exposing injuredshaft and epiphysis. Step 3.—With strong hooks make traction on the diaphysis and epiphysis(Fig. 1102) or attain the same purpose by other means. During the abovemanoeuvre slowly flex the knee and so reduce the displacement. Step 4.—If the fragments tend to remain in good position, pass on to Step the fragments do not tend to remain in good position apply periosteal sutures(good in any case) or bone pegs or any of the established means of is more important to avoid irritating means of fixation in case of epiphys
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