. Medical and surgical reports. outer aspect of the externalcondjde below the epiphyseal line. If, in a mild degree ofseparation, there is little or no detachment of these muscles,they will simply be put on the stretch and will evidently tendto prevent, after reduction, a tendency for the fragment to slipforward again, as they will antagonize the pull of the quadri-ceps; in other cases, however, the injury is likely to be severeenough to have caused detachment of the gastrocnemius andpopliteus from the epiphyseal fragment; thus, the quadriceps 200 SEPARATION OF FEMORAL EPIPHYSIS. pull is not a
. Medical and surgical reports. outer aspect of the externalcondjde below the epiphyseal line. If, in a mild degree ofseparation, there is little or no detachment of these muscles,they will simply be put on the stretch and will evidently tendto prevent, after reduction, a tendency for the fragment to slipforward again, as they will antagonize the pull of the quadri-ceps; in other cases, however, the injury is likely to be severeenough to have caused detachment of the gastrocnemius andpopliteus from the epiphyseal fragment; thus, the quadriceps 200 SEPARATION OF FEMORAL EPIPHYSIS. pull is not antagonized, and the recurrence of the forwarddislocation easily takes place. In some cases, especially com-pound separations, the difficulty of reduction appears to be dueto a strip of torn capsule or fascia, which is interposed betweenepiphysis and lower end of diaphysis. The extended positionof the lower leg will, of course, tend to put such a band on thestretch, and traction alone on the leg may fail to remove this PLATE Case 8 (1).- Showing lower end of femur 6 yearsafter injury. mechanical obstacle. By flexion of the knee joint this bandwill become relaxed, and may by proper manipulation be workedout of its position of interference with reduction. Symptoms and Diagnosis.— Any case of injury to the kneein a patient below twenty (the age of ossification of the epi-physis) is suggestive of epiphyseal separation. In the classicalcase the appearance is that of a fracture of the lower end of thefemur with certain distinctive features; namely, the marked SEPARATION OF FEMORAL III. 201
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