. Manual of operative surgery. Fig. I106. Fig. 1107. Figs. 1106 and 1107.—Barkers Fig. 1108.—Barkers operation. SUTURE PATELLA 927 Step 4.—Thread the needle with the end of wire protruding through theupper opening and withdraw it. The wire now surrounds the broken bone. Step 5.—Approximate the fragments of bone. Tighten the wire and twistits two ends snugly. Cut off the excess of wire. Bury the twisted part of thewire beneath the skin, if necessary enlarging the original needle puncture forthis purpose with a knife. A modification of Barkers method is as follows: Steps i and 2 as a


. Manual of operative surgery. Fig. I106. Fig. 1107. Figs. 1106 and 1107.—Barkers Fig. 1108.—Barkers operation. SUTURE PATELLA 927 Step 4.—Thread the needle with the end of wire protruding through theupper opening and withdraw it. The wire now surrounds the broken bone. Step 5.—Approximate the fragments of bone. Tighten the wire and twistits two ends snugly. Cut off the excess of wire. Bury the twisted part of thewire beneath the skin, if necessary enlarging the original needle puncture forthis purpose with a knife. A modification of Barkers method is as follows: Steps i and 2 as 3.—Approximate the fragments of bone. Apply a firm pad over the the ends of the wire over the pad and twist them tight (Fig. 1108). (B) Open Operation. (i) Classical Operation.—Step i.—Make a vertical incision in the middleline from a point about one inch above the upper fragment to a similar pointbelow the lower fragment. Reflect the soft parts (exclusive of the periosteumwhich must not be disturbed) to either side as so to freely expose the fractureds


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