A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . lished. In untreated or improperly treatedcases the permanent separation between the fragments may be threeor four inches. Use of a quite well repaired fracture of the patella hasoften caused the fibrous union to stretch, and the stretching may begreater on one side than on the other. Osseous union occasionally takesplace, but many close fibrous unions have been mistaken during life forbony repair. Nodules of bone are at times f
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . lished. In untreated or improperly treatedcases the permanent separation between the fragments may be threeor four inches. Use of a quite well repaired fracture of the patella hasoften caused the fibrous union to stretch, and the stretching may begreater on one side than on the other. Osseous union occasionally takesplace, but many close fibrous unions have been mistaken during life forbony repair. Nodules of bone are at times found in the fibro-ligamen-tous tissue between the fragments. Rupture of the bond holding thepieces together or fracture near the point of union is not secondary accidents show at times little attempt at union. Whenthe tissues have become rigid and adherent about the seat of fractureand there still remains some stiffness of the joint, the integument maybe torn and the joint laid open at the time the secondary fracture open fractures so caused and those originally open are, of course,very serious injuries, unless managed Close ligamentous union resembling bony union.(Leviss specimen in Mutter Museum.) FRACTURES OF THE PATELLA. 469 Upper fragment. Fig. 243. Lowerfragment A severe arthritis may leave a stiff knee ; and, even in ordinary cases,free motion of the limb may not be attained for six months. This ispartly due to the fear of tearing or stretching the ligamentous unionby early attempts at motion,which induces the surgeonand the patient to insist uponprotracted wearing of splintsand abstinence from strongpassive movements. The fearis a well grounded one. Afterfreedom of flexion and exten-sion of the joint has finallybeen gained, the disabilityfrom fibrous union, even aninch in length, is not verygreat. The patient mayscarcely limp; though a rapidgait or the ascending and de-scending of stairs will showhis imperfect power of control
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