American practice of surgery : a complete system of the science and art of surgery . ing those of a transverse fracture above the condyles. Thelower fragment is tilted to the front, while the end of the upper projects backinto the popliteal space. Crepitus is softer than the bony kind. Reductionmay be effected by means of extension and manipulation, and union securedby immobilization with a well-padded posterior splint and a plaster-of-Parisdressing. I wish to reiterate the injunction to look well to the blood supply of thelimb below the point of injury, more especially in all fractures of the
American practice of surgery : a complete system of the science and art of surgery . ing those of a transverse fracture above the condyles. Thelower fragment is tilted to the front, while the end of the upper projects backinto the popliteal space. Crepitus is softer than the bony kind. Reductionmay be effected by means of extension and manipulation, and union securedby immobilization with a well-padded posterior splint and a plaster-of-Parisdressing. I wish to reiterate the injunction to look well to the blood supply of thelimb below the point of injury, more especially in all fractures of the lowerextremity. Fractures of the Patella. Recent Fractures. Fractures of the patella represent two per cent of all fractures, and theytherefore constitute a common accident. The superficial location of the bone,with its special function and strong muscular attachments, will help to explainthis frequency. The patella is essentially a sesamoid bone developed in thetendon of the quadriceps extensor muscle. The causes of its fracture are muscular contraction and direct force, either. FRACTURES. 183 of which may act separately or both may act together. Muscular action usu-ally produces a transverse fracture (Fig. 82), but in very rare instances theline of the fracture runs in a vertical direction, owing in part, it is thought, tothe fact that the vasti muscles, because of their peculiar rela-tions to the lateral aspects of the knee-cap, pull upon it inopposite directions when the leg is flexed. The bone is less frequently broken by direct violence thanby muscular contraction. Direct violence produces various formsof fracture, the oblique, vertical, and star-shaped lines being Fig. 82.—Trans-the most Common. verse Fracture of As just before stated, external violence and muscular con- the Patella- (H- . Rieffel, in Le traction often cooperate in the causation of this fracture. Dentu et Deibet:Either of these causes may operate primarily, or they may Traite de Chi- ... ... _ . . rur
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