The treatment of fractures . d perceptibly by this pas-sive motion and lasting pain is absent, it may be persisted in withregularly increasing amounts. At the expiration of eight orten weeks active motion at the knee-joint may cautiously beallowed. The appearance of persistent and increasing tender-ness, sensitiveness, or pain, and increasing separation of the frag-ments are the indications to diminish or cease passive and activemotions. EXPECTANT ENT 333 Summary of the Treatment of Fracture of the Patella by theExpectant or Nonoperative Method.—During four weeks fixa-tion of the knee,
The treatment of fractures . d perceptibly by this pas-sive motion and lasting pain is absent, it may be persisted in withregularly increasing amounts. At the expiration of eight orten weeks active motion at the knee-joint may cautiously beallowed. The appearance of persistent and increasing tender-ness, sensitiveness, or pain, and increasing separation of the frag-ments are the indications to diminish or cease passive and activemotions. EXPECTANT ENT 333 Summary of the Treatment of Fracture of the Patella by theExpectant or Nonoperative Method.—During four weeks fixa-tion of the knee, elastic compression, douching, massage, thethigh flexed slightly on pelvis, the leg extended, retentive straps,coaptation splints, are the measures employed. At the fourth orsixth week, remove all apparatus, apply removable splint, allowwalking with crutches, and use daily passive motion. At theeighth week, discard crutches, use cane, and permit limited dailyactive motion. At the sixth month, discard splint, apply flannel. Fig. 466.—Fracture of upper third of patella, showing separation of fragments. Tilting of theupper fragment through rotation upon its transverse axis (X-ray tracing). bandage, and discard cane. At the eighth to the tenth month,remove all support. Open Fracture of the Patella.—This is a very serious in-jury, because one of the largest synovial cavities of the body isexposed to infection. It is safest and wisest to lay open the knee-joint, to thoroughly irrigate it with a solution of corrosive sub-limate (1 : 10,000), and then with a sterilized normal salt blood-clots should be carefully wiped away. All looselyattached fragments of bone should be removed. Particularattention should be paid to the posterior parts of the joint, behind 334 FRACTURES OF THE PATELLA the condyles of the femur. It will be found convenient in clean-ing these parts first to flush the joint with sterile salt solutionand to flex and to extend the knee. All parts of the
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