A system of surgery : pathological, diagnostic, therapeutic, and operative . sion, the nature of the accident is at once detectable bythe change in the contour of the knee, by the inability to extend the limb, and by the displacement of the upper fragment, asseen in fig. 439. In many cases the person isconscious, at the moment of the injury, of some-thing having given way, and perhaps he mayhave even heard the peculiar characteristic he attempts to get up and walk, he will bealmost sure to fall, from his inability to extendthe leg and support the weight of the body uponit. The displace
A system of surgery : pathological, diagnostic, therapeutic, and operative . sion, the nature of the accident is at once detectable bythe change in the contour of the knee, by the inability to extend the limb, and by the displacement of the upper fragment, asseen in fig. 439. In many cases the person isconscious, at the moment of the injury, of some-thing having given way, and perhaps he mayhave even heard the peculiar characteristic he attempts to get up and walk, he will bealmost sure to fall, from his inability to extendthe leg and support the weight of the body uponit. The displacement is usually considerable,the superior fragment. being drawn upwardsupon the fore part of the thigh by the extensormuscles. The height to which it may be carriedvaries according to the extent of the destructionof the ligamentous connection of the tendon ofthese muscles. When the separation is com-plete, it may amount to two and a half, three,and even four inches, while under opposite cir-Fracture of the patella. cumstances it may not exceed six, eight, or ten Fig. CHAP. VIII. FEACTURES OF THE PATELLA. 947 lines. The distance between the two fragments is always increased by bendingthe leg. The front of the knee has a flattened appearance, and upon passingthe finger over it its point will be found to sink down abruptly as it were intothe joint. The lower fragment is stationary, but the upper is easily moved, andmay, by thorough extension of the limb, be brought down into its normal situa-tion, so as to enable us to detect crepitus. If some time has elapsed since theoccurrence of the accident, considerable swelling may be present, obscuring some-what the diagnosis. In respect to its niode of union, the transverse fracture of the patella holdsthe same relation as a similar injury of the olecranon. In both cases the nutri-tion of the fragments is seriously impaired by the laceration of the vessels, andin both great difficulty is experienced in maintaining coaptation. Hence
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