A manual of operative surgery . mmered down (Fig. 446) into the groovesalready made in the periosteum. Drainage of the knee-joint isnot required, and introduces an element of risk. The skin-woundis sewn up, and the limb placed in a comfortable position ( too fully extended) on a back-splint. As soon as the woundhas soundly healed, in from two to three weeks, the patient isencouraged to bend the knee. The wire should be left in, as itis an important element of strength, preventing re-fracture. CHAP. II ! FRACTURED PATELLA 717 Massage and gentle passive motion should be employed at theend
A manual of operative surgery . mmered down (Fig. 446) into the groovesalready made in the periosteum. Drainage of the knee-joint isnot required, and introduces an element of risk. The skin-woundis sewn up, and the limb placed in a comfortable position ( too fully extended) on a back-splint. As soon as the woundhas soundly healed, in from two to three weeks, the patient isencouraged to bend the knee. The wire should be left in, as itis an important element of strength, preventing re-fracture. CHAP. II ! FRACTURED PATELLA 717 Massage and gentle passive motion should be employed at theend of a fortnight. Some surgeons use only one wire, but withthis it is more difficult to secure good apposition. Modifications of the Operation, etc.—Some surgeons object tothe use of silver wire on the ground that it will have to be removedlater. The answer to this is that it should never be necessaryto remove the wire. We have followed up many cases years afterwiring, and in no single instance had the wire caused any trouble-. FIG. 446.—FROM RADIOGRAPH OF WIRED FRACTURE- OF PATELLA, TAKEN THREE YEARS AFTER THE OPERATION. The two silver wire loops are shown ; perfect bony union has occurred. Note the twistedends of the wires hammered down. In fact, if the ends have been properly buried in the periosteumit becomes impossible in most cases to detect the wire by palpa-tion later. We are strongly in favour of using two wires, andboth of good thickness, for these reasons :— (1) We have known a single wire to cut through, andthe fracture to re-open three months after the operation(Fig. 447). (2) We have had to operate a second time for a fracturewhich we had wired two months before, with two wires ofslightly lesser calibre than we usually employed. The 718 OPERATIONS ON BONES AND JOINTS [part vii patient in stepping from a tramcar broke both wires, andre-opened the fracture. (3) The patella forms new bone, it mends a break, withmore difficulty and slowness than almost any bone i
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